Scenario Based Quiz - Coverage terminated

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1. If the claim with date of service - 05/01/2023 is billed to insurance and the patient's policy was effective from 05/15/2022 and is still active then will the claim be denied for coverage terminated? Yes
No
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2. If the claim with date of service - 03/01/2023 is billed to insurance and the patient's policy was effective from 02/15/2022 and termed on 12/01/2022 then will the claim be denied for coverage terminated? Yes
No
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3. If you receive the status on call as the claim is denied for coverage terminated then what will be your first valid question? Could you please send the claim back for reprocessing since policy active on DOS?
What is the TAT for reprocessing?
May I have the policy effective and termed date?
None of the above
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4. If you receive the status on call as the claim is denied for coverage terminated and the DOS lies between the policy effective and termed date then what will be your next questions? Could you please send the claim back for reprocessing since policy active on DOS?
What is the TAT for reprocessing?
May I get the Claim# & Call ref#?
All of the above
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5. If you receive the status on call as the claim is denied for coverage terminated and the DOS does not lie between the policy effective and termed date then what will be your next question? Is there any other policy active for patient on DOS?
May I have policy ID, Policy effective and termed date?
May I have the policy effective and termed date?
None of the above
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6. If you receive the status on call as the claim is denied for coverage terminated and the DOS does not lie between the policy effective and termed date and there is another policy active on DOS then what will be your next question? Is there any other policy active for patient on DOS?
May I have policy ID, Policy effective and termed date?
May I have the policy effective and termed date?
None of the above
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7. If the claim is denied for coverage terminated incorrectly and the rep sends the claim back for reprocessing then what will be your action? Resubmit the claim with the new policy ID
Release the claim to the patient
Set the follow-up for the TAT
None of the above
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8. If the claim is denied for coverage terminated and the rep provided the policy details of another policy which is active on DOS then what will be your action? Resubmit the claim with the new policy ID
Release the claim to the patient
Set the follow-up for the TAT
None of the above
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9. If the claim is denied for coverage terminated correctly and there is no other active policy and insurance on DOS then what will be your action? Resubmit the claim with the new policy ID
Release the claim to the patient
Set the follow-up for the TAT
None of the above
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10. If the claim is denied for coverage terminated correctly and there is another insurance available in the system then what will be your action? Resubmit the claim to another insurance if active for DOS without making it as primary insurance
Resubmit the claim to another insurance if active for DOS after making it as primary insurance
Resubmit the claim to another insurance even if inactive for DOS after making it as primary insurance
Resubmit the claim to another insurance even if inactive for DOS without making it as primary insurance
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