Scenario Based Quiz - Referral is absent or missing

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1. If you receive the status on call as the claim is denied for referral is absent or missing and the patient plan is HMO or POS then what will be your next step?




2. If you receive the status on call as the claim is denied for referral is absent or missing and the patient plan is HMO or POS and you find the referral in the system then what will be your next question?




3. If you receive the status on call as the claim is denied for referral is absent or missing and the patient plan is HMO or POS and you do not find the referral in the system then what will be your next question?




4. If you receive the status on call as the claim is denied for referral is absent or missing and the patient plan is HMO or POS and you do not find the referral in the system but the rep finds the referral on his/her system or on the hospital claim then what will be your next question?




5. If you receive the status on call as the claim is denied for referral is absent or missing and the patient plan is HMO or POS and you do not find the referral in the system and rep does not find the referral on his/her system or on the hospital claim then what will be your next questions?




6. If you receive the status on call as the claim is denied for referral is absent or missing and the patient plan is PPO or EPO then what will be your next question?




7. If the claim is denied for the referral is absent or missing and the patient is HMO or POS and the referral is available in the system and the rep sends the claim back for reprocessing then what will be your action?




8. If the claim is denied for the referral is absent or missing and the patient is HMO or POS and the referral is not available in the system and the rep does not find the referral on his/her system or on the hospital claim then what will be your action?




9. If the claim is denied for the referral is absent or missing and the patient is HMO or POS and the referral is not available in the system but the rep finds the referral on his/her system or on the hospital claim and sends claim back for reprocessing then what will be your action?




10. If the claim is denied for referral is absent or missing and the patient is PPO or EPO and the rep sends the claim back for reprocessing then what will be your action?








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9 comments:

  1. Nagapur Dheeraj Sai13 September 2023 at 08:36

    Excellent Quiz and there should be weekly one Quiz on different Denials.

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    Replies
    1. ARLearning Team16 September 2023 at 05:50

      Not possible on a weekly basis but we will post it bi-weekly. Thanks for your comment.

      Delete
    2. Anonymous11 December 2023 at 12:51

      when will you do that , please post more to gain more knowledge

      Delete
  2. Anonymous15 September 2023 at 05:12

    This is the best way to keep important. Make it happen once per month.

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    Replies
    1. ARLearning Team16 September 2023 at 06:11

      We will post it biweekly. Thanks for your comment.

      Delete
  3. Anonymous23 February 2024 at 06:53

    very useful, keep up the good work

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  4. Anonymous20 March 2025 at 07:39

    8. If the claim is denied for the referral is absent or missing and the patient is HMO or POS and the referral is not available in the system and the rep does not find the referral on his/her system or on the hospital claim then what will be your action? I answer for this questions as - need to send the appeal and even in scenario it was mentioned as same. Unfortunately answer wrong and correct answer is work as per client instructions. Will you please explain on this.

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    Replies
    1. ARLearning Team5 April 2025 at 08:01

      In the scenario, it is mentioned that for this question you can either send an appeal or write off the claim and advised to work as per client's instruction. Please check the scenario again.

      Delete