Question 1

A policyholder or __________ is the person in whose name the insurance policy is issued.

Accepted Answer

A)   beneficiary
B)   employee
C)   patient
D)   providerE) A) and B)
F) All of the above

Question 2

A pre-existing condition is any medical condition that was diagnosed and/or treated within a specified period of time __________ the enrollee's effective date of coverage.

Accepted Answer

A)   after
B)   beforeC) A) and B)
D) undefined

Question 3

Which is the insurance plan responsible for paying health care insurance claims first?

Accepted Answer

A)   primary insurance
B)   secondary insurance
C)   supplemental insurance
D)   tertiary insuranceE) C) and D)
F) None of the above

Question 4

Which is the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the insurance company is obligated to pay any benefits?

Accepted Answer

A)   coinsurance
B)   copayment
C)   deductible
D)   premiumE) None of the above
F) B) and C)

Question 5

A clearinghouse that involves value-added vendors, such as banks, in the processing of claims is called a value-added __________ to improve efficiency and reduce expenses.

Accepted Answer

A)   network
B)   organization
C)   reseller
D)   systemE) All of the above
F) C) and D)

Question 6

Any procedure or service reported on the claim that is not included on the master benefit list is a noncovered benefit and will result in claims __________.

Accepted Answer

A)   approval
B)   denial
C)   payment
D)   submissionE) C) and D)
F) All of the above

Question 7

Secondary insurance is the insurance plan that is billed after the primary insurance plan has paid its contracted amount and the provider's office has received a(n)  __________ from the primary payer.

Accepted Answer

A)   CMS-1500 claim
B)   encounter form
C)   explanation of benefits
D)   remittance adviceE) A) and D)
F) B) and D)

Exam 4: Processing an Insurance Claim

Which is the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the insurance company is obligated to pay any benefits?

Correct Answer
verified

A clearinghouse that involves value-added vendors, such as banks, in the processing of claims is called a value-added __________ to improve efficiency and reduce expenses.

Correct Answer
verified

A pre-existing condition is any medical condition that was diagnosed and/or treated within a specified period of time __________ the enrollee's effective date of coverage.

Correct Answer
verified

Which is the insurance plan responsible for paying health care insurance claims first?

Correct Answer
verified

A policyholder or __________ is the person in whose name the insurance policy is issued.

Correct Answer
verified

Any procedure or service reported on the claim that is not included on the master benefit list is a noncovered benefit and will result in claims __________.

Correct Answer
verified

Secondary insurance is the insurance plan that is billed after the primary insurance plan has paid its contracted amount and the provider's office has received a(n) __________ from the primary payer.

Correct Answer
verified

Exam 4: Processing an Insurance Claim

Which is the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the insurance company is obligated to pay any benefits?

Correct AnswerverifiedShow Answer

A clearinghouse that involves value-added vendors, such as banks, in the processing of claims is called a value-added __________ to improve efficiency and reduce expenses.

Correct AnswerverifiedShow Answer

A pre-existing condition is any medical condition that was diagnosed and/or treated within a specified period of time __________ the enrollee's effective date of coverage.

Correct AnswerverifiedShow Answer

Which is the insurance plan responsible for paying health care insurance claims first?

Correct AnswerverifiedShow Answer

A policyholder or __________ is the person in whose name the insurance policy is issued.

Correct AnswerverifiedShow Answer

Any procedure or service reported on the claim that is not included on the master benefit list is a noncovered benefit and will result in claims __________.

Correct AnswerverifiedShow Answer

Secondary insurance is the insurance plan that is billed after the primary insurance plan has paid its contracted amount and the provider's office has received a(n) __________ from the primary payer.

Correct AnswerverifiedShow Answer

Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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