BCBS Word Scramble

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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

Created by: theresav