Scenario Based Quiz - Authorization absent or missing

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1. If you receive the status on call as the claim is denied for authorization absent or missing and you find the authorization in your system then what will be your next question?




2. If you receive the status on call as the claim is denied for authorization absent or missing and you find the authorization in your system and the rep agrees to reprocess the claim then what will be your next question?




3. If you receive the status on call as the claim is denied for authorization absent or missing and you find the authorization in your system and the rep denies to reprocess the claim and asks to send the corrected claim then what will be your next question?




4. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is an emergency service then what will be your next question?




5. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is not an emergency service then what will be your next question?




6. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is not an emergency service and the rep finds the Auth# in their system or on the hospital claim then what will be your next question?




7. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is not an emergency service and the rep is unable to find the Auth# in their system or on the hospital claim then what will be your next question?




8. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is not an emergency service and the rep is unable to find the Auth# in their system or on the hospital claim but obtaining retro authorization is possible then what will be your next question?




9. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is not an emergency service and the rep is unable to find the Auth# in their system or on the hospital claim and obtaining retro authorization is not possible then what will be your next questions?




10. If the claim is denied for authorization absent or missing and Auth# is available in the system and the rep sends claim back for reprocessing then what will be your action?




11. If the claim is denied for authorization absent or missing and Auth# is available in the system but the rep denies to reprocess the claim and asks to send the corrected claim then what will be your action?




12. If the claim is denied for authorization absent or missing and Auth# is not available in the system and the service is an emergency service and the rep agrees to reprocess the claim then what will be your action?




13. If the claim is denied for authorization absent or missing and Auth# is not available in the system and the service is not an emergency service and the rep finds Auth# on the hospital claim and agrees to reprocess the claim then what will be your action?




14. If the claim is denied for authorization absent or missing and Auth# is not available in the system and the service is not an emergency service and the rep does not find Auth# in their system or on the hospital claim but says it is possible to obtain retro authorization and provides the procedure to obtain retro authorization then what will be your action?




15. If the claim is denied for authorization absent or missing and Auth# is not available in the system and the service is not an emergency service and the rep does not find Auth# in their system or on the hospital claim and says it is not possible to obtain retro authorization then what will be your action?








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26 comments:

  1. Anonymous8 August 2023 at 14:13

    15. If the claim is denied for authorization absent or missing and Auth# is not available in the system and the service is not an emergency service and the rep does not find AUTH # on the hospital claim but says it is not possible to obtain retro authorization then what will be your action?
    Ans:- Write off the claim is not correct answer ,after denied the appeal we have to write off the bal, before sending the appeal we can not write off the balance

    ReplyDelete
    Replies
    1. AR11 August 2023 at 12:53

      It is not always needed to send an appeal. It can also be written off. But, yes it differs from client to client and thanks for your comment. It makes sense that it may create a confusion for many. So, we have updated the answers.

      Delete
  2. Anonymous9 August 2023 at 07:47

    I scored 15/15 yipeeeeeee

    ReplyDelete
  3. Anonymous10 August 2023 at 04:05

    I scored 14/15

    ReplyDelete
  4. Anonymous10 August 2023 at 16:16

    14/15

    ReplyDelete
  5. Anonymous24 August 2023 at 08:36

    15/15 yuppppppppppp

    ReplyDelete
  6. Parootgouda28 August 2023 at 08:23

    14/15

    ReplyDelete
  7. Anonymous29 August 2023 at 11:20

    I scored 13/15

    ReplyDelete
  8. Nagapur Dheeraj Sai13 September 2023 at 10:27

    I scored 15/15

    ReplyDelete
  9. Anonymous20 September 2023 at 13:02

    I scored 13 yooooo

    ReplyDelete
  10. Anonymous1 October 2023 at 18:01

    If you receive the status on call as the claim is denied for authorization absent or missing and you find the authorization in your system and the rep agrees to reprocess the claim then what will be your next question? Answer :What is turn around time for processing?..is it correct?

    ReplyDelete
    Replies
    1. AR8 October 2023 at 03:53

      Yes, it is correct based on the below authorization scenario. You can share your thoughts if you think any other option is correct.

      https://www.arlearningonline.com/2019/11/197-precertificationauthorizationnotifi.html

      Delete
  11. Anonymous2 November 2023 at 10:16

    I scored 15/15 thaankss to ...

    ReplyDelete
  12. Anonymous21 November 2023 at 07:30

    Congratulations!!! You scored 15 out of 15
    Score 10 out of 10

    ReplyDelete
  13. Siddhesh Kadam QA8 February 2024 at 06:02

    15/15

    ReplyDelete
  14. Anonymous4 June 2024 at 13:44

    welldone

    ReplyDelete