Quantum Health- Final Exam Questions and Answers 100% Solved
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Course
Quantum Health-
Institution
Quantum Health-
Quantum Health- Final Exam Questions
and Answers 100% Solved
How long does it take for pharmacy claims to process? - Immediately
(Real Time)
Why would a PCP's name in PIVIT be highlighted yellow? - needs
updating or verification
A member calls and tells you that they were just diagnosed with ...
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? - ✔✔Incentive Management Program
People who have an established relationship with a PCP spend on average
____ less on healthcare - ✔✔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? -
✔✔Doctor's name, Facility ( Billing address), and Tax ID
What 3 pieces of information do we need to properly look up a claim -
✔✔date of service, amount of claim, and provider name
What are the two main functions of a TPA - ✔✔Administer the plan and pay
claims
Why does an employer hire a network for their plan - ✔✔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) - ✔✔NPI for Preforming Facility
What Benefit would you quote for Botox Injections - ✔✔Office Surgery
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