Scenario Based Quiz - Patient cannot be identified

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1. What could be the reason for the patient not found denial? Incorrect Account Number
Incorrect phone number
Correct patient name, Date of birth, or Gender
Incorrect patient name, Date of birth, or Gender
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2. If the rep is unable to find the patient with policy ID but is able to find the patient after doing a patient name, DOB, and SSN search then what will be your next question? May I have the correct policy ID?
Could you please check if claim is available for the DOS with correct member ID?
Both of the above
None of the above
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3. If the rep is unable to find the patient with policy ID but is able to find the patient after doing a patient name, DOB, and SSN search but there is no claim on file and the patient policy is active on DOS and the DOS has crossed the TFL and there is a POTF available then what will be your next question? May I have the Timely filing limit(TFL)?
Can we fax or mail the claim along with POTF?
May I have the effective and termed date of the policy?
None of the above
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4. If the rep is unable to identify the patient with policy ID then what will be your step? Will ask for the call ref# and release the claim to the patient
Will ask the rep to search the patient by name, DOB, or SSN
Will follow the AR scenario as per the claim status
None of the above
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5. If the rep is unable to find the patient after doing a policy ID, name, DOB, and SSN search then what will be your action? Will release the claim to the patient even if there is another insurance available
Will release the claim to the patient if found another active primary insurance
Will resubmit the claim to another insurance even if the policy is inactive
Will release the claim to the patient if no other active insurance is available
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6. If the rep is unable to find the patient with policy ID but is able to find the patient after doing a patient name, DOB and SSN search and is able to find the claim as well then what will be your next step? Will ask for policy details
Will ask for TFL details
Will follow the AR scenario as per the status of the claim
None of the above
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7. If the rep is able to find the patient with the patient name, DOB, or SSN search but is unable to find the claim and the patient policy is not active on DOS and there is no other active insurance then what will be your action? Resubmit the claim to the same insurance
Release the claim to the patient
Write off the claim
None of the above
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8. If the patient not found denial is received from Medicare insurance and you are unable to find the correct details and there is an active secondary insurance which is Medicare supplementary plan then what will be your action? Resubmit the claim to the Medicare supplementary insurance after flipping it to primary insurance
Resubmit the claim to the Medicare supplementary insurance without flipping it to primary insurance
Release the claim to the patient
None of the above
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9. If the rep is unable to find the patient with policy ID but is able to find the patient after doing a patient name, DOB, and SSN search but the claim is not on file and the patient policy is active on DOS and the DOS is within TFL then what will be your action? Resubmit the claim with the old policy ID
Resubmit the claim with a new policy ID
Release the claim to the patient
None of the above
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10. If the rep is unable to find the patient with policy ID but is able to find the patient after doing a patient name, DOB, and SSN search but the claim is not on file and the patient policy is active on DOS and the DOS has crossed the TFL and there is no POTF available then what will be your action? Resubmit the claim to the same insurance
Release the claim to the patient
Write off the claim
None of the above
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