What is a ppo plan - Study guides, Class notes & Summaries

2024 Anthem Administrative Guidelines Exam I completed all my training on Friday. When will I know I'm ready to sell? - ANS Only after receipt of the confirmation email should arrive on Monday. Training completed one day should be validated the following business day. What tool does BlueCross provide for you to submit notes taken during the meeting with a prospect? - ANS Cavulus If a member chooses to cancel or withdraw an enrollment application or terminate enrollment in a plan o...

H has suffered a covered disability away from her job and will shortly begin collecting benefits. The insurer sends a letter to H stating that she will not receive any benefit amounts greater than her income. This clause is known as: A: Over-insurance clause B: free look C: relation of earning to insurance D: relation of economic value - answer-C: relation of earning to insurance The insured should be aware of the issue date upon delivery a policy and the date should be listed on: A: the...

Kentucky Life and Health Insurance Exam (New 2024/ 2025 Update) Questions and Verified Answers| 100 % Correct| Grade A QUESTION The only party in an insurance contract that makes a legally enforceable promise is the insurance company. Because of this, insurance contracts are considered to be: conditional aleatory unilateral contracts of adhesion Answer: unilateral Insurance contracts are unilateral. This means that only one party (the insurer) makes any kind of ...

Steps used to control costs of managed care include: - ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - ANSWER-HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings...

CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 Steps used to control costs of managed care include: Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage HMO Conventional PPO and POS H...

Certain conditions, such as dismemberment or total and permanent blinds, will automatically qualify the insured for full disability benefits. Which disability policy provision does this describe? - presumptive disability Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss? - notice of claim Because an insurance policy is a legal contract, it must conform to the state laws governing contracts which require all of the following el...

PTCB Pharmacy Billing and Reimbursement Practice Test Questions and Answers Latest Rated 100%. DAW/DNS stand for which of the following? A. Dispense as written B. Distribute and work C. Distribution and working D. Dispense as well 3. Which of the following third party plans requires the patient to designate a primary care physician (PCP)? A. Health maintenance organization (HMO) B. Preferred provider organization (PPO) C. Medicare Part D D. TRICARE 4. The cost of the coverage of an i...

Pharmacy Billing and Reimbursement PTCB Practice Test Questions and Answers Latest Rated A+. Which government insurance plans offers 4 different parts or areas of different coverage? A. MedicareB. Medicaid C. TRICARE D. CHAMPVA 2. DAW/DNS stand for which of the following? A. Dispense as written B. Distribute and work C. Distribution and working D. Dispense as well 3. Which of the following third party plans requires the patient to designate a primary care physician (PCP)? A. Health ...

AHIP 2024 Certification Version 2 All New Qs & As for A++ Exam - Guaranteed Pass! 1. Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollmentin a Medicare prescription drug plan because, although she is entitled to PartA, she is not enrolled under Medicare Part B. What should you tell her? Answer: An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, ...

INTRODUCTORY MEDICAL SURGICAL NURSING 12TH EDITION TIMBY SMITH TEST BANK [Author name] [COMPANY NAME] [Company address] INTRODUCTORY MEDICAL SURGICAL NURSING 12TH EDITION TIMBY SMITH TEST BANK 1. CHAPTER 1 Managed care organizations are insurers that carefully plan and closely supervise the distribution of healthcare services. What is one of the goals of managed care? A) Preventing illness through screening and promotion of health activities B) Improving training of healthcare professionals C) E...

RN ATI Fundamentals (10.0) Chapter 1 1. A nurse is discussing restorative health care with a newly licensed nurse. Which of the following examples should the nurse include in the teaching? (Sele ct all that apply.) a. Home health care b. Rehabilitation facilities c. Diagnostic centers d. Skilled nursing facilities e. Oncology centers 2. A nurse is explaining the various types of health care coverage clients might have to a group of nurses. Which of the following health care financing mechanisms ...

TEST BANK : MEDICAL SURGICAL NURSING: CONCEPTS & PRACTICE 3RD EDITION BY deWit (CHAPTER 1-48)Chapter 01: Caring for Medical-Surgical Patients Chapter 02: Critical Thinking and the Nursing Process Chapter 03: Fluid, Electrolytes, Acid-Base Balance, and Intravenous Therapy Chapter 04: Care of Preoperative and Intraoperative Surgical Patients Chapter 05: Care of Postoperative Patients Chapter 06: Infection Prevention and Control Chapter 07: Care of Patients with Pain Chapter 08: Care of Patients wi...