Scenario Based Quiz - Claim not on file

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1. If the claim is not on file then what will be your first valid question?




2. If the claim is not on file and the rep provided the policy effective and termed date but the DOS does not lie between the effective and termed date then what will be your next question?




3. If the claim is not on file and the DOS lies between the effective and termed date and the rep provided the TFL and the DOS is within the TFL then what will be your next question?




4. If the claim is not on file and the DOS lies between the effective and termed date and the rep provided the TFL but the DOS has crossed the TFL then what will be your next question?




5. If the claim is not on file and the DOS lies between the effective and termed date and the rep provided the TFL but the DOS has crossed the TFL and the rep confirmed that you can fax or mail the claim along with POTF then what will be your next question?




6. If the claim is not on file and the patient was inactive on DOS and there is no other policy active on DOS then what will be your action?




7. If the claim is not on file and the patient was inactive on DOS and the rep said there is another policy active on DOS and provided policy details then what will be your action?




8. If the claim is not on file and the patient was active on DOS but when you checked the clearing house then you come to know that claim was rejected through the clearing house. What will be your action?




9. If the claim is not on file and the patient was active on DOS and DOS lies within the TFL but the claim was billed with an incorrect payer ID then what will be your action?




10. If the claim is not on file and the patient was active on DOS but DOS is not within the TFL and the rep said you can fax the claim along with POTF and you do have POTF then what will be your action?








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17 comments:

  1. Anonymous26 May 2023 at 10:00

    best question

    ReplyDelete
  2. Anonymous4 June 2023 at 11:16

    Amazing 👍 website , it's very useful for me thanks a lot.

    ReplyDelete
  3. Anonymous9 June 2023 at 09:55

    This is awesome! Keep Going

    ReplyDelete
  4. Anonymous26 July 2023 at 02:41

    perfect to practice the scenarios

    ReplyDelete
  5. Anonymous19 September 2023 at 12:58

    for the Question If the claim is not on file and the patient was inactive on DOS and there is no other policy active on DOS then what will be your action?, the answer you guys mentioned is relies claim to patient where we can not bill patient with out EOB or any other proof. we need to resubmit claim and after it denies for eligibility issue, can bill to patient. please change it.

    ReplyDelete
    Replies
    1. AR23 September 2023 at 02:09

      You may be following this in your process as per the client's instruction which is correct. But, it would not be the same for everyone.

      In general, even a patient would not deny it if he/she will check the insurance card or inquire with the insurance company. So, the proof is already available.

      Delete
  6. Anonymous26 February 2024 at 10:50

    Osm

    ReplyDelete
  7. Dheeraj sai28 March 2024 at 11:59

    Scored 10/10

    ReplyDelete
  8. Anonymous5 June 2024 at 08:10

    Thank you so much , its so informative to me aswell.

    ReplyDelete
  9. Anonymous26 July 2024 at 07:09

    Its very helpfull , Thank you.

    ReplyDelete