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Health Insurance

Commerical Insurance

QuestionAnswer
When a patient is covered by a large employer group health plan (EGHP) and Medicare, which is primary? employer group health plan (EGHP)
When a child who is covered by two or more plans lives with his married parents, the primary policyholder is the parent whose birthday occurs first in the year.
When the provider's Social Security number is entered in Block 25 of the CMS-1500 claim, the number contains the identification number without hyphens or spaces.
When the CMS-1500 claim requires spaces for data entry of a date, the data is entered as which of the following? MM DD YYYY or MM DD YY
Entering an X in the Other box on the CMS-1500 claim indicates that the patient is covered by an individual or family health plan, and can also indicate that the claim should be processed by a(n) __________ payer. automobile or liability
When the CMS-1500 claim requires a response to YES or NO entries, enter X
When SIGNATURE ON FILE is the appropriate entry for a CMS-1500 claim block, which is also acceptable as an entry? SOF
date the patient first experienced signs or symptoms of an illness or injury (or the date of last menstrual period for obstetric visits).The provider does document that pain began five days ago. Today is May 10, YY. What do you enter in Block 14? 05 05 YY
Blocks 24A–24J of the CMS-1500 claim contain shaded rows, which can contain supplemental information, per payer instructions.
If a physician is reporting level 3 subsequent hospital services provided to a hospital inpatient on 05/10/YY and 05/11/YY, what is entered in Block 24A of the CMS-1500 claim? 05 10 YY 05 11 YY
What is entered in Block 24J of the CMS-1500 claim if the provider is a member of a group practice? National Provider Identifier (NPI)
When Block 25 of the CMS-1500 contains the provider's employee identification number (EIN), enter _____ after the first two digits of the EIN. no punctuation or space
When a patient is covered by the same primary and secondary commercial health insurance plan, submit just one completed CMS-1500 to the same plan.
When entering the patient's name in Block 2 of the CMS-1500 claim, separate the last name, first name, and middle initial (if known) with commas
Block 33a of the CMS-1500 claim contains the provider's NPI
Which typically covers the medical expenses of individuals and groups, and is either purchased by individuals or provided by employers? Commercial insurance
Which specifically compensates policyholders for actual economic losses, up to limiting amounts on the insurance policy, and usually requires the insured to prove losses before payment is made? Indemnity insurance
Which is a contract between an individual and an insurance company whereby the individual pays a premium and, in exchange, the insurance company agrees to pay for specific car-related financial losses during the term of the policy? Automobile insurance
Which covers income lost as a result of a temporary or permanent illness or injury? Disability insurance
Which is a policy that covers losses to a third party caused by the insured, such as by an object owned by the insured, or on premises owned by the insured? Liability insurance
Which specifically refers to the contractual right of a third-party payer to recover health care expenses from a liable party? Subrogation
When a patient is injured on the job, which type of insurance is responsible for reimbursing the patient's health care expenses? Workers' compensation
Third-party recovery standards for the investigation of liability coverage and the process for filing a lien in a potential liability case vary according to federal or state law. Which is an example of a lien? Pledging or securing a debtor's property as a guarantee of payment for a debt
Secondary health insurance plans provide coverage similar to that of __________ plans. primary
Which benefit program is most likely to be implemented by employers to retain high-quality employees and ensure productivity? Preventive medical care to create a healthy workforce
Created by: tbharris
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