Scenario Based Quiz - Primary Paid More Than Secondary Allowed Amount

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1. When does a CPT get denied for denial 23? When primary insurance pays less than the secondary allowable amount
When primary insurance pays more or an equal amount to the secondary allowable amount
When primary insurance pays $0.00 and applies the whole allowed amount to patient responsibility
None of the above
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2. If you receive the status on call as the claim is denied as the primary paid more than secondary allowed amount and you find that the primary insurance has paid less than the secondary allowed amount then what will be your next valid questions? Could you please reprocess the claim as primary PA is less than secondary AA?
What is the TAT for reprocessing?
What is the fax# to send an appeal?
All of the above
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3. If the claim is denied as the primary paid more than secondary allowed amount and you find that the primary insurance has already paid more than the secondary allowed amount then what will be your action? Resubmit the claim with the correct modifier
Assign the claim to the coding team
Write off the claim
Set the follow-up for the TAT
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4. If the claim is denied as the primary paid more than secondary allowed amount and you find that the primary insurance has paid less than the secondary allowed amount and the rep agrees to send the claim back for reprocessing then what will be your action? Resubmit the claim with the correct modifier
Assign the claim to the coding team
Write off the claim
Set the follow-up for the TAT
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5. If a CPT with a billed amount of $100.00 is denied by primary insurance for denial 23 then what will be your action? Call the insurance and confirm the denial reason
Release the claim to the patient
Write off the CPT
None of the above
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6. If a CPT with a billed amount of $150.00 is allowed by primary insurance for $40.00, paid for $30.00 and patient responsibility is $10.00 as coinsurance. For secondary insurance, the allowed amount for the same CPT is $35.00 then how much amount will be paid by secondary insurance? $0.00 (Claim will get denied for 23)
$5.00
$10.00
$35.00
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7. If a CPT with a billed amount of $200.00 is allowed by primary insurance for $60.00, paid for $45.00 and patient responsibility is $15.00 as coinsurance. For secondary insurance, the allowed amount for the same CPT is $60.00 then how much amount will be paid by secondary insurance? $0.00 (Claim will get denied for 23)
$10.00
$15.00
$45.00
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8. If a CPT with a billed amount of $250.00 is allowed by primary insurance for $80.00, paid for $64.00 and patient responsibility is $16.00 as coinsurance. For secondary insurance, the allowed amount for the same CPT is $64.00 then how much amount will be paid by secondary insurance? $0.00 (Claim will get denied for 23)
$16.00
$20.00
$64.00
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9. If a CPT with a billed amount of $130.00 is allowed by primary insurance for $35.00, paid for $0.00 and patient responsibility is $35.00 as Deductible. For secondary insurance, the allowed amount for the same CPT is $35.00 then how much amount will be paid by secondary insurance? $0.00 (Claim will get denied for 23)
$5.00
$30.00
$35.00
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10. If a CPT with a billed amount of $170.00 is allowed by primary insurance for $50.00, paid for $20.00 and patient responsibility is $30.00 (Deductible - $20.00 and Coinsurance - $10.00). For secondary insurance, the allowed amount for the same CPT is $20.00 then how much amount will be paid by secondary insurance? $0.00 (Claim will get denied for 23)
$10.00
$20.00
$30.00
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