Scenario Based Quiz - Additional information requested from patient

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1. What is the use of Coordination of Benefit? It provides authority to the insurance company to make the payment of the patient's health services directly to the provider once signed by the patient
It provides authority to providers to share patients' protected health information with insurance while ensuring the privacy of patients
It helps to determine which insurance is primary, secondary, or tertiary
None of the above
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2. What is the correct reason for the claim to be denied for denial code - 227? A. Additional information is requested from the provider
B. Additional information is requested from the patient
C. The claim is paid to the patient
D. Both B & C
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3. If you receive the status on call as the claim is pending for additional information is requested from the patient then will you ask for a denial date? Yes
No
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4. If you receive the status on call as the claim is pending for additional information is requested from the patient then what will be your next valid question? When did you sent the letter to the patient?
Have you received any response from patient?
What information have you requested from patient?
What is the TAT for reprocessing?
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5. If you receive the status on call as the claim is pending for additional information is requested from the patient and the rep confirms that the COB information is requested from the patient by sending a letter then what will be your next questions? A. When did you sent the letter?
B. Have you received any response from patient?
C. Both A & B
D. None of the above
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6. If you receive the status on call as the claim is pending for additional information requested from the patient and the rep confirms that the COB information is requested from the patient and they have received the response from the patient then what will be your next questions? Could you please reprocess the claim?
What is the TAT for reprocessing?
May I have the claim# & call ref#?
All of the above
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7. If the claim is pending for the COB/Other information is requested from the patient and the letter has already been sent and the response has also been received from the patient and the rep agrees to reprocess the claim then what will be your action? Release the claim to the patient
Set the follow-up for the TAT
Resubmit the claim to secondary insurance
Send an appeal to the insurance
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8. If the claim is denied for the additional information is requested from the patient as the patient needs to update COB information and the letter is not sent then what will be your action? Release the claim to the patient
Set the follow-up for the TAT
Resubmit the claim to secondary insurance
Send an appeal to the insurance
Click here to go on AIRFP (Patient) scenario

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9. If the claim is pending for the COB/Other information is requested from the patient and the letter has already been sent but the response has not been received from the patient and the date when the letter is sent has not crossed 30 days then what will be your action? Release the claim to the patient
Set the follow-up for the TAT
Resubmit the claim to secondary insurance
Work as per the client's instructions
Click here to go on AIRFP (Patient) scenario

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10. If the claim is pending for the the COB/Other information is requested from the patient and you check the payment history and find that the nearby DOS is paid by another insurance then what will be your action? Will check the eligibility of another insurance and if it is active on DOS as primary then update that insurance as primary and submit the claim to that insurance
Will release the claim to the patient
Will submit the claim to another insurance without checking the eligibility
Will check the eligibility of another insurance and submit the claim to that insurance even if it is inactive on DOS
Click here to go on AIRFP (Patient) scenario

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