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? May I have the claim#?
Can we fax or mail the claim along with POTF
May I have policy effective and termed date?
None of the above
Click here to go on CNOF scenario

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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? Is there any other policy active for the patient on DOS?
Can we fax or mail the claim along with POTF?
May I have the claim#?
None of the above
Click here to go on CNOF scenario

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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? May I have the claim#?
May I have claim mailing address, Payer ID and Fax#?
Can we fax or mail the claim along with POTF?
None of the above
Click here to go on CNOF scenario

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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? May I have the claim#?
Is there any other policy active for the patient on DOS?
Can we fax or mail the claim along with POTF?
None of the above
Click here to go on CNOF scenario

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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? May I have the claim#?
Is there any other policy active for the patient on DOS?
May I have Fax# or Mailing address to send claim along with POTF?
None of the above
Click here to go on CNOF scenario

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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? Resubmit the claim
Release the claim to the patient
Send claim through fax
None of the above
Click here to go on CNOF scenario

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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? Resubmit the claim with the previous policy ID
Release the claim to the patient
Fax the claim along with POTF
Update the correct policy ID and resubmit the claim
Click here to go on CNOF scenario

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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? Resubmit the claim
Release the claim to the patient
Work according to rejection
None of the above
Click here to go on CNOF scenario

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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? Resubmit the claim with the previous payer ID
Release the claim to the patient
Update the insurance with the correct payer ID and resubmit the claim
None of the above
Click here to go on CNOF scenario

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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? Resubmit the claim with the previous payer ID
Release the claim to the patient
Write off the claim
Fax the claim along with POTF
Click here to go on CNOF scenario

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