Scenario Based Quiz - Maximum benefit exhausted/reached

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1. If a service is allowed to pay for $2,000.00 in a year and insurance has already paid the same service for $2,000.00 in a year. So, when the same service is again billed to insurance in the same year, it is denied for the maximum benefit reached. Is the claim denied correctly? Yes
No
Click here to go on Benefit Exausted scenario

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2. If a service is allowed to pay for 10 times in a year and insurance has already paid the same service for 8 times in a year. So, when the same service is again billed to insurance for the 9th time in the same year, it is denied for the maximum benefit reached. Is the claim denied correctly? Yes
No
Click here to go on Benefit Exausted scenario

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3. If you receive the status on call as the claim is denied as the patient has reached the maximum benefit allowed then what will be your next valid question? How much Dollar amount is allowed?
How much visit has patient met excluding this claim?
May I know maximum benefit reached in terms of dollar or visit?
None of the above
Click here to go on Benefit Exausted scenario

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4. If you receive the status on call as the claim is denied as the patient has reached the maximum benefit allowed in terms of dollars then what will be your next questions? How many Visit is allowed?
How much visit has patient met excluding this claim?
Both of the above
None of the above
Click here to go on Benefit Exausted scenario

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5. If you receive the status on call as the claim is denied as the patient has reached the maximum benefit allowed in terms of visit then what will be your next questions? How many Visit is allowed?
How much visit has patient met excluding this claim?
Both of the above
None of the above
Click here to go on Benefit Exausted scenario

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6. If you receive the status on call as the claim is denied as the patient has reached the maximum benefit allowed in terms of dollar or visit and the patient has not met the allowed dollar amount or visit excluding this claim then what will be your next questions? Could you please send the claim back for reprocessing since patient has not met the the allowed dollar amount or visit excluding this claim?
What is the TAT for reprocessing?
May I have the claim# & call ref#?
All of the above
Click here to go on Benefit Exausted scenario

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7. If the claim is denied as the patient has reached the maximum benefit allowed in terms of dollar and the patient has met the allowed dollar amount excluding this claim and there is no secondary insurance available then what will be your action? Resubmit the claim to secondary insurance
Release the claim to the patient
Set the follow-up for the TAT
None of the above
Click here to go on Benefit Exausted scenario

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8. If the claim is denied as the patient has reached the maximum benefit allowed in terms of dollars and the patient has not met the allowed dollar amount excluding this claim and sends the claim back for reprocessing then what will be your action? Submit the claim to secondary insurance
Release the claim to the patient
Set the follow-up for the TAT
None of the above
Click here to go on Benefit Exausted scenario

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9. If the claim is denied as the patient has reached the maximum benefit allowed in terms of visit and the patient has met the allowed visit excluding this claim and there is secondary insurance available then what will be your action? Will submit the claim to secondary insurance even if it is not active on DOS
Will submit the claim to secondary insurance only if it is active on DOS
Release the claim to the patient
None of the above
Click here to go on Benefit Exausted scenario

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10. If the claim is denied as the patient has reached the maximum benefit allowed in terms of visit and the patient has met the allowed visit excluding this claim and there is secondary insurance available that is active on DOS then what will be your correct action? Submit the claim to secondary insurance after flipping it to the primary position
Resubmit the claim to the primary insurance
Submit the claim to secondary insurance without changing its position
All of the above
Click here to go on Benefit Exausted scenario

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