Scenario Based Quiz - Non Covered Charges

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1. What are the reasons for the denial of non-covered changes as per the patient plan? Provider is out of network
Non-covered DX or ICD-10 code under patient policy
Non-covered CPT code under patient policy
All of the above
Click here to go on Non Covered scenario

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2. If you receive the status on call as the claim is denied for non-covered charges as per patient plan then what will be your next valid question? Is it non covered as per patient plan or provider contract?
What is the time frame to submit the corrected claim?
What is the reason for non covered?
None of the above
Click here to go on Non Covered scenario

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3. If you receive the status on call as the claim is denied for non-covered charges as per the patient plan as the DX or ICD-10 is not covered then what will be your next valid question? Is it non covered as per patient plan or provider contract?
What is the time frame to submit the corrected claim?
What is the reason for non covered?
None of the above
Click here to go on Non Covered scenario

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4. If you receive the status on call as the claim is denied for non-covered charges as per the provider contract as the CPT is non-covered then what will be your next step? Will ask the rep to reprocess the claim
Will check the payment history if the payment received for same CPT with the same provider from the same insurance
Will ask for appeal details
None of the above
Click here to go on Non Covered scenario

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5. If you receive the status on call as the claim is denied for non-covered charges as per the provider contract as the CPT is non covered and the payment has already been received for the same CPT with the same provider from the same insurance then what will be your next valid question? Could you please send claim back for reprocessing since we have received payment for same procedure?
What is the TAT for reprocessing?
What is fax# or Appeal address to send the appeal?
All of the above
Click here to go on Non Covered scenario

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6. If you receive the status on call as the claim is denied for non-covered charges as per the provider contract as the CPT is non-covered and the payment is already received for the same CPT with the same provider from same insurance and the rep agrees to send the claim back for reprocessing then what will be your next valid question? Could you please send claim back for reprocessing since we have received payment for same procedure?
What is the TAT for reprocessing?
What is fax# or Appeal address to send the appeal?
All of the above
Click here to go on Non Covered scenario

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7. If you receive the status on call as the claim is denied for non-covered charges as per provider contract as the CPT is non-covered and the payment is already received for the same CPT with the same provider from the same insurance and the rep asks to send an appeal then what will be your next valid questions? What is fax# or Appeal address to send the appeal?
How much is the appeal limit?
May I have the claim# & call ref#?
All of the above
Click here to go on Non Covered scenario

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8. If you receive the status on call as the claim is denied for non-covered charges as per the provider contract as the CPT is non-covered and the payment is not received for the same CPT with the same provider from the same insurance then what will be your next valid questions? What is fax# or Appeal address to send the appeal?
How much is the appeal limit?
May I have the claim# & call ref#?
All of the above
Click here to go on Non Covered scenario

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9. If the claim is denied for non-covered charges as per the patient plan as the provider is out of network then what will be your action? Resubmit the claim to secondary insurance
Follow the provider is out of network scenario
Assign the claim to the coding team
Release the claim to the patient
Click here to go on Non Covered scenario

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10. If the claim is denied for non-covered charges as per the patient plan as the DX or ICD-10 is not covered then what will be your action? Resubmit the claim to secondary insurance
Follow the provider is out of network scenario
Assign the claim to the coding team
Release the claim to the patient
Click here to go on Non Covered scenario

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11. If the claim is denied for non-covered charges as per the patient plan as the DX or ICD-10 is not covered and received a coding response as 'there is no alternative code' 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 Non Covered scenario

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12. If the claim is denied for non-covered charges as per the patient plan for other reasons and there is a secondary insurance available but it is inactive on DOS then what will be your action? Resubmit the claim to secondary insurance
Follow the provider is out of network scenario
Assign the claim to the coding team
Release the claim to the patient
Click here to go on Non Covered scenario

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13. If the claim is denied for non-covered charges as per the provider contract and the payment is already received for the same CPT with the same provider from the same insurance and rep agrees to send the claim back for reprocessing then what will be your action? Resubmit the claim to secondary insurance
Set the follow-up for the TAT
Assign the claim to the coding team
Release the claim to the patient
Click here to go on Non Covered scenario

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14. If the claim is denied for non-covered charges as per the provider contract and the payment is already received for the same CPT with the same provider from the same insurance and the rep asks to send an appeal then what will be your action? Send an appeal to the insurance
Set the follow-up for the TAT
Assign the claim to the coding team
Release the claim to the patient
Click here to go on Non Covered scenario

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15. If the claim is denied for non-covered charges as per the provider contract and the payment is not received for the same CPT with the same provider from the same insurance then what will be your action? Send an appeal to the insurance
Write off the claim
Work as per the client's instructions
All of the above
Click here to go on Non Covered scenario

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