Quantum Health- Final UPDATED Actual Exam Questions and CORRECT Answers
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Course
Quantum Health
Institution
Quantum Health
Quantum Health- Final UPDATED Actual
Exam Questions and CORRECT Answers
How long does it take for pharmacy claims to process? - CORRECT ANSWER-
Immediately (Real Time)
Why would a PCP's name in PIVIT be highlighted yellow? - CORRECT ANSWER-
needs updating or verification
Quantum Health- Final UPDATED Actual
Exam Questions and CORRECT Answers
How long does it take for pharmacy claims to process? - CORRECT ANSWER-
✔✔Immediately (Real Time)
Why would a PCP's name in PIVIT be highlighted yellow? - CORRECT ANSWER-
✔✔needs updating or verification
A member calls and tells you that they were just diagnosed with a serious medical condition
that will require surgery and a lot of rehab. They just want to make sure that is the best and
only option that they have. What kind of point solution would you suggest for them? -
CORRECT ANSWER- ✔✔Second opinion
What do you call a group of doctors, hospitals, and other healthcare providers that are
contracted to offer their services for a lower than usual rate - CORRECT ANSWER-
✔✔Specialty/Narrow Network
What section of Smart Benefit Search would you go to in order to quote a sick office visit
with a pediatrician - CORRECT ANSWER- ✔✔PCP- Office Visit
What does DME stand for? - CORRECT ANSWER- ✔✔durable medical equipment
In which section of SBS would you look for information on specific requirements an
employee would need to satisfy in order to get a lower premium? - CORRECT ANSWER-
✔✔Incentive Management Program
People who have an established relationship with a PCP spend on average ____ less on
healthcare - CORRECT ANSWER- ✔✔30
When calling the network to verify whether a provider participates to not, what are the 3
pieces of information you need to obtain before calling? - CORRECT ANSWER-
✔✔Doctor's name, Facility ( Billing address), and Tax ID
, What 3 pieces of information do we need to properly look up a claim - CORRECT
ANSWER- ✔✔date of service, amount of claim, and provider name
What are the two main functions of a TPA - CORRECT ANSWER- ✔✔Administer the plan
and pay claims
Why does an employer hire a network for their plan - CORRECT ANSWER- ✔✔To save
money and provide services at discounted (contracted) rate
When building a Pre-Determination for an office procedure, what provider will you input in
the top right hand corner of the Pre-D? (Physician/Facility field of the form) - CORRECT
ANSWER- ✔✔NPI for Preforming Facility
What Benefit would you quote for Botox Injections - CORRECT ANSWER- ✔✔Office
Surgery
what kind of nurse preforms daily concurrent for inpatient members? - CORRECT
ANSWER- ✔✔UR Nurse
At Quantum, How many pieces of information are you required to get from the member or
provider prior to giving out PHI? - CORRECT ANSWER- ✔✔3
What benefit would you quote for a CPAP machine - CORRECT ANSWER- ✔✔Durable
medical equipment
What are all of the places where you can locate an EOB - CORRECT ANSWER- ✔✔-TPA
(Most Accurate)
-Member Website
-Claims wizard
On a precert, which two pieces of information make it turn green or red - CORRECT
ANSWER- ✔✔Place of service & CPT Code
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