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Coding
Commercial Ins/ BCBS
| Question | Answer |
|---|---|
| preferred provider network | requires providers to adhere to managed care provisions |
| when same payer issues the primary, secondary, or supplemental policies | you would submit one claim for all policies |
| mandatory second surgical system is necessary when | patient is considering elective, non-emergency surgical care |
| correct way for the patient's date to appear on CMS-1500 | MM DD YYYY |
| BCBS indemnity coverage | offers choice and flexibility who want to receive full range of benefits |
| On the CMS-1500 form the patient's names should appear as | last name, first name, middle initial separated by commas |
| Block 11a on the CMS-1500 should be left blank if | policyholder's gender is unknown |
| BCBS fee-for-service is also known as | traditional coverage |
| Supplemental health insurance usually cover | deductible, copayment, coinsurance |
| Block 6 of the CMS- 1500 if patient is an unmarried domestic partner | an X should be placed in the box |
| Block 24 of the CMS claim is limited to report how many services | six |
| Riders are | special clauses stipulating additional coverage over and above the standard contract |
| Disability insurance covers | reimbursement for income lost as a result of a temporary or permanent illnesses or injury |
| exclusive provider organization is similar to | an HMO |
| Remittance advice is attached when | completing secondary claims |
| BCBS plans initiated in 1929 provided coverage for | hospital bills |
| insurance that covers losses to a third party caused by the insured is called | liability insurance |
| when patient is covered by two different policies, what is the proper way to submit claims | when primary submitted first , followed by the secondary after primary payment is done |
| In 1938 BS was created originally covered | physician services |
| what does SOF in block 12 mean | patient signed at an earlier visit (signature on file) |
| Healthcare anywhere means | allowing members to have access to benefits throughout the US. and world |
| A POS system allows | subscribers to choose between a network provider or out-of-network provider |
| primary care provider, personal care physician, personal care provider is known as a | PCP |
| On block where you SOF what date would you enter | no date is necessary, leave blank |
| BCBS PPO plan is | a subscriber driven program |
| A special accident injury rider covers | 100% of nonsurgical care rendered within 24 to 72 hours |
| When filling in block 1 on the CMS-1500 claim what do you enter when filing a commercial insurance clain | if BCBS is not listed you check off group |
| Why it is important to check each payer when completing commercial claims | check for updates, if need alternative information, discover any new implementations |
| What identification letter is on the Government-Wide -Service benefit plan | R |
| Copy of the patients insurance card should be maintained where | in the patient's file |
| "acute respiratory infection or "bladder infection | are not considered emergency diagnoses |
| If a patient is covered by primary and secondary or supplemental BCBS health insurance plans | modifications are made to the CMS-1500 claim |
| If patient has not been discharged at the time the claim is completed what goes in block 18 | leave the discharge date blank |
| BCBS includes | fee-for-service, managed care, Medicare supplement plans |
| EPO is similar to | an HMO |
| Patien mailing address | Block 5 |
| Block 4 | Name of primary card holder |
| Name of provider, Name of office, address, Zio code, Phone number | Block 33 |
| Name of provider, date od service | Block 31 |
| Patients name: last, first and middle initial | block 2 |
| Block 27 | always check the YES box this is payment to the office |
| Enter EIN number of the provider | block 25 |
| Block 24(F) | enter the charge for each listed service |
| Enter the procedure code for service and supplies | Block 24 (D) |
| This is the code for the place of service such as office or hospital | Block 24 (B) |
| Block 21(A) | List the ICD-10-CM codes used during the time of service, and the date of service it shoul be the same for from and to |
| This is where you enter the diagnosis codes in alphabetical order(signsture on file | Block 21 |
| Block 1 A | ID number of the card holder |
| Date of current illness | Block 14 DD/MM/YYYY |
| Block 12 | signature of physician or SOF |
| Name of insurance company | Block 11 c |
| Block 11b | leave blank |
| birth date of card holder and whether they are male or female | block 11a |
Created by:
gward2612