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BCBS
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Question | Answer |
---|---|
Blue Cross and Blue Shield originated as 2 seperate entities selling what? | Prepaid medical plans. |
The first Blue Shield plan originated where? | Palo Alto, Ca |
What are the special contract clauses that stipulate additional coverage for health care services? | riders |
Blue Cross/Blue Shield policy holders are known as what? | Members |
When is a second surgical opinion (SSO) required? | elective surgery |
Coordinate home health and hospice care provides the member an option to what? | alternatives to acute care settings |
In 1939 the American Hospital Association became the approving agent for what? | Accreditation of new prepaid hospital plans. |
Profit earned is reinvested in where for nonprofit organizations? | the organization |
True or false, taxes are piad on profits for profit organizations | True |
Taxes are paid on profits and then profits are distributed to who with for-profit organizations? | shareholders and officers |
UCR | Usual, Customary and Reasonable |
In what year did Blue Cross and Blue Shield merge to form BCBSA? | 1986 |
Precertification is a form of what? | Prospective authorization |
What percentage of non surgical care is paid when a patient has purchased the special accidental injury rider policy if caare is rendered within the policie's specific guidelines? | 100% |
Annual deductibles vary according to the ________ in which the patient is enrolled | plan |
Assignment of benefits means what? | payment will be sent directly to the provider |
in what year did Blue Cross and Blue Shield national associations vote to combine personnel under the leadership of one president responsible to both boards? | 1977 |
File how many claims if the primary and secondary payer is the same insurance company | one |
Can a physician choose to participate or not with commercial plans? | yes |
Are dependent names printed on the Federal Employee Progaram (FEP) id cards? | no |
How long do providers customarly have to file a claim for riembursement after the patient receives treatment? | 1 year |
The amount of the patient's copayment depends on what? | the patient's insurance plan |
What conditions do not qualify under the medical emergency rider as covered? | Chronic conditions |
is BCBS the only payer contracted with the federal government to reimbuse health care services for federal employees? | no |
Services routinely included in BCBS basic coverage | Hospitalizations, Diagnostic lab services, X-rays, surgical fees, Assist Surgeon fee's, OB Care, intensive care, newborn care & cemo for cancer |
When is the 3 digit enrollment code entered as the group ID number? | for Federal Employee Program claims |
6 BCBS program types are | fee for service (taditional), Indemnity, Managed care plans, Federal Employee Programs (FEP), Medicare supplemental plans & Healthcare anywhere |
True or False, BCBS plans are forbidden to cancel individual policies based on 2 factors, because he/she is in poor health or payments to providers have fare exceeded the average. | true |
Mark what in block 1 of the CMS-1500 claim with an X to indicate an individual commercial claim | other |
What is primary when the patient is covered by her employer's grop insurance plan and her spouse's group insurance plan | employer sponsored plan |
what must be omitted when entering the ID number on the CMS-1500 claim for in block 1a | spaces |
what is entered in block 25 of the CMS-1500 claim | tax ID number of the billing entity |
Waht is entered in Block 15 of the CMS-1500 claim form | the first date the patient was seen or treated for a prior episode of the same of smiilar problem |
on the commercial claim CMS-1500 what should be entered in block 16 | dates during which the patient was unable to work |
Block 24g of the CMS-15000 claim requires entry of the number of what of the service/pricedure peorted in 24d | days or units |
If the provider has agreed to accept assingment what is marked in Box 27 of the CMS-1500 claim | Yes |
when entering a modifer on the CMS-1500 claim you separate the modifer from the CPT/HCPCS code number by using a space or a dash? | space |
In block 18 of the CMS-1500 claim the eight digit whats are entered of the patient received inpatient serives | admission and discharge |
Block 19 of the CMS-1500 is used for what? | left blank or to discribe a procedure code such as CPT code 99070 |
Block 24h of the CMS-1500 is only used for what type of claim? | Medicaid |
Block 24i is preprinted so you do what? | leave it blank |
Block 24B of the claim form requires you to enter what? | place of service code |
What goes in block 17 of the claim form | provider's full name and credentials of the professional |
what goes in block 11a | policy holder's date of birth and gender |
What goes in Block 9 if the patiens has only one insurance policy | left blank |
when is BCBS forbidden to cancel individual polices? | when he/she is in poor health and when payments provided to the provider far exceeds the average |
What are the 6 BCBL program types | traditional, indemnity, Managed care, Feder Empolyee Program, Medicare supplemental plans and Healthcare anywhere |
name 6 services routinely included in BCBS basic coverage | Hospitalizations, diagnostic lab services, x-rays, surgical fees, Assist surgeon fees, OB Care, intensive care, newborn care & chemo for cancer |