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Health Insurance
Blue Cross Blue Shield
| Question | Answer |
|---|---|
| BCBS preferred provider networks are responsible for | ensuring that members receive accessible, appropriate, cost-effective, and quality health care services. |
| Patients who receive coordinated home health care program services must require | skilled nursing services on an intermittent basis under the primary care provider's direction. |
| Patients who receive care from __________ providers can expect to pay higher costs. | non-network |
| Which service is provided as part of BCBS basic coverage? | Prescription drugs |
| Which service is provided as part of BCBS major medical coverage only? | Vision |
| Traditional fee-for-service plans provide reimbursement to providers | according to a fee schedule after procedures have been performed or services provided to members. |
| BCBS indemnity provides members with the option to receive care from any provider, and they may cost __________ than other health plans, such as fee-for-service and managed care plans. | more |
| The preauthorization of physical, occupational, and speech therapy services is a requirement for BCBS managed care plans as part of its __________ program. | outpatient pretreatment authorization Hide Feedback |
| Which phrase is located on a Federal Employee Program® insurance identification card? | Government-Wide Service Benefit Plan |
| Which symbol is included on a BCBS identification card to indicate that members selected plans that allow them to access health care benefits throughout the United States and around the world? | Suitcase |
| BlueCross BlueShield claims filed by participating providers qualify for assignment of benefits, which means payment is made directly to the | provider. |
| When entering the provider's Social Security number (SSN) or employer identification number (EIN) in Block 25 of the CMS-1500 claim, a | hyphen is not entered. |
| When the same BCBS payer issues the primary and secondary or supplemental policies, submit __________ CMS-1500 claim(s). | one combined |
| When a patient receives professional services from a provider in the office setting and BCBS payers for the member's primary and secondary policies are different companies, submit | he CMS-1500 claim to the primary payer, and then after payment, submit a second claim to the secondary payer with a copy of the primary payer's remittance advice. |
| BCBS is considered secondary when the patient is covered by a | Medicare plan and a BCBS supplemental Medigap plan. |
Created by:
tbharris
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