Scenario Based Quiz - Claim applied towards deductible

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1. If the policyholder has a deductible clause of $1,500.00 per year and the first treatment of a policyholder costs $2,000.00 then how will the claim get processed?




2. If the policyholder has a deductible clause in terms of visits and it is for initial 3 visits and the policyholder has already taken 3 visits and undergoes for the fourth visit that costs $800.00 then how will the claim get processed for the fourth visit?




3. If the claim is applied towards the deductible and the patient has not met the deductible including the current claim then what will be your next question?




4. If the claim is applied towards the deductible and the patient has already met the deductible excluding the current claim then what will be your next question?




5. If the claim is applied towards the deductible and the patient has not met the deductible including the current claim and you have received the EOB through fax then what will be your action?




6. If the claim is applied towards the deductible and the patient has already met the deductible excluding the current claim and the rep sent the claim back for reprocessing then what will be your action?




7. If the deductible is posted in the system and no other active secondary insurance is available then what will be your action?




8. If the deductible is posted in the system and secondary insurance is available then what will be your action?




9. If the claim is processed by Medicare as primary and applied towards deductible and the deductible is also posted in the system and there is a secondary insurance that is active then what will be your next step?




10. If the claim with a bill amount of $200.00 is processed out of network and allowed for $40.00 and the whole amount is applied towards deductible then what will be the patient responsibility?








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20 comments:

  1. Anonymous18 June 2023 at 09:45

    good place to learn thanx guys, keep forward.

    ReplyDelete
  2. Anonymous19 June 2023 at 17:26

    Amazing to learn but how to know which questions i did incorrectly.

    ReplyDelete
    Replies
    1. AR24 June 2023 at 13:29

      Select your answer and click on 'Submit' button. You will get to know whether your answer is correct or incorrect.

      Delete
  3. Anonymous4 July 2023 at 09:15

    Could you please describe the first and third questions from the quiz claim applied towards deductible?

    ReplyDelete
    Replies
    1. AR5 July 2023 at 14:15

      Thanks for your response. The answers to both questions were mapped incorrectly. We have made the correction. If your response was to point out the errors then thank you so much, we need such feedback. Or else if you are still confused about these questions. Please reply with the questions.

      Delete
  4. Anonymous7 July 2023 at 02:28

    Could you please explain Question No. 10

    ReplyDelete
    Replies
    1. AR8 July 2023 at 14:26

      It is correct. When the claim is processed out-of-network then the out-of-network provider can bill the entire amount to the patient.

      Delete
  5. Anonymous12 July 2023 at 01:51

    How to check answer is right

    ReplyDelete
    Replies
    1. AR13 July 2023 at 07:59

      Select your answer and click on the 'Submit' button.

      Delete
  6. Anonymous2 August 2023 at 11:44

    Please double check the Question No 10. Sometimes provider charge extra money to out of network patient so how is this possible all will be applied PR1 and how is this possible that patient will pay this amount.

    ReplyDelete
    Replies
    1. AR3 August 2023 at 14:45

      In question no. 10, we have asked about patient responsibility, not only about PR1 - deductible. Deductible will remain the same whatever is applied by the insurance. But when the claim is processed out of network, the provider can bill the full amount to the patient.

      Delete
  7. Anonymous23 August 2023 at 04:17

    could you please explain the 10th answer?

    ReplyDelete
    Replies
    1. AR25 August 2023 at 15:02

      When the claim is processed out-of-network then the out-of-network provider can bill the entire amount to the patient.

      Delete
    2. Anonymous22 March 2024 at 10:27

      Yes we will bill the entire billed amount to the patient. Ex B.A = $200, A.A = $40 (DED), C.A $160 since the OON provider does'nt have C.A we are billing the C.A + Ded to the patient which is $200. now the C.A for OON provider will be considered as "PR4".

      regards,
      Infy

      Delete
  8. Anonymous24 October 2023 at 10:52

    yes

    ReplyDelete
  9. Anonymous1 March 2024 at 09:55

    Can you please enlighten me 10th question? given the patient has out of network benefits, should we still bill the full amount to the patient?

    ReplyDelete
    Replies
    1. AR3 March 2024 at 09:01

      In general, when the claim is processed out of network, the provider can bill the full amount to the patient. But, please follow your process update when working, it may differ.

      Delete
  10. Anonymous26 May 2024 at 01:21

    Its more helpful in Quiz if we get correct answers for incorrectly filled after submit

    ReplyDelete
    Replies
    1. AR2 June 2024 at 02:01

      Thanks for your suggestion. But, when we started to work on the quiz portion, we decided that instead of providing a correct answer, we could provide a link to the post where the user can go through the post and try to find out the correct answer to clear out his/her doubts.

      In other way, user can still select any option and click on submit to find out the correct answer.

      Delete