Claims administrator - Study guides, Class notes & Summaries

Arizona Life Insurance Exam Questions and Answers (Latest Update 2023) Verified Answers a whole life policy that provides a choice of dividend options include the following statement about dividends they accrue at a guaranteed rate they are deferred for one year they are not guaranteed they are guaranteed after the first year - Correct Answers they are not guaranteed When there is a named beneficiary on a life insurance policy, the death benefits 1. are directed to a trustee ...

QME Exam Questions and Answers Already Passed Which types of reports are typically used in evaluations? Initial (Comprehensive) Subsequent (Follow-up) Additional (Supplemental) What is a factual correction report? A factual correction report is a specific type of supplemental report focused exclusively on reviewing the medical records that were available during the evaluation. When can a factual correction request be made for unrepresented workers? Such requests can be made...

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...

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...

FDLE SOCE Review Exam Questions With Correct Answers Latest 2023/2024 (100% Correct). A correctional probation officer is responsible for: - ANSWER-• performing professional work to investigate and assess offenders • ensuring that offenders comply with any statutory or special conditions of supervision ordered by the sentencing authority • evaluating offender progress and making recommendations throughout the period of supervision • assisting offenders in securing employment and ma...

Medical Office Administration Questions and Answers Already Passed How do medical office administrators handle patient billing and insurance claims? Medical office administrators process billing by generating invoices, submitting insurance claims, and following up on unpaid claims or denied charges. What are the key elements to include in a patient’s medical record? Key elements include personal information, medical history, treatment plans, progress notes, and results from di...

Florida 3-20 Public Adjuster Exam Outlines Latest 2023 Rated A+ There are several important statutory requirements pertaining to contracts made by public adjusters: Must state the type of claim, including an emergency claim, non-emergency claim or supplemental claim. Requires the signatures of all named insureds. If the signatures of all named insureds are not available, the public adjuster must submit an affidavit signed by the available named insureds attesting that they have authority to ent...

An organization outside the members of a self-insurance group which, for a fee, processes claims, completes benefits paperwork and often analyzes claims information is known as the: 1) primary administrator (PA). 2) second-party administrator (SPA) 3) third party administrator (TPA) 4) administrator. -Correct Answer According to the NAIC Model Health Insurance Policy Provisions, under the _________________________ provision, the insurer is prohibited from denying a claim on the basis...

What is the penalty, if a community fails to report that they are declaring bankruptcy, foreclosure or facing eviction? - Considered a 2nd degree MISDENIEANOR Where should resident funds and property be held for safekeeping? - in a Florida banking institution. A POA, Power of Attorney is also called... - an Attorney-in-Fact Who/ what is considered a controlling interest of an ALF? - Anyone or entity that holds 5% or more ownership interest in the community. When a controlling interest is in...

claim a demand by a person or business seeking to recover from an insurer for a loss that may be covered by an insurance policy claimant anyone who submits a claim to an insurer first party the insured in an insurance contract third party a person or business who is not a party to the insurance contract bu who asserts a claim against the insured claim representative (or adjuster) a person responsible for verifying coverage, determining the cause of loss, determining the amount of damages ...

AIC 30 Latest Update with Verified Solutions First Party Focus Coverage and Amount of damage Second Party Insurance Company First Party Insured Third Party Claimant Third Party Focus Liability, Coverage, and Amount of damage Third Party Administrator (TPA) an organization that provides admin services associated with risk financing and insurance. They handle claims and risk management for self-insured organizations Independent Adjuster handles claims for the insurer for ...