CPB Chapter 13: Commercial Carriers
QUIZ - correct answer-QUIZ
Which modifier is used to indicate that an E&M service is unrelated to the global service?
a. 24
b. 25
c. 59
d. 79 - correct answer-a. 24
If a provider wishes to submit for a first level provider payment review form Cigna, what is
the timeframe for this type of dispute?
a. 60 days
b. 90 days
c. 180 days
d. 365 days - correct answer-c. 180 days
Which of the following denials is one of the leading reasons a claim is denied and can be
prevented by accurate intake information being collected every time?
a. Medical necessity
b. Coordination of Benefits
c. Request for medical records not received
d. Incorrect patient information - correct answer-d. Incorrect patient information
According to the policy, how many steps is in the Aetna dispute and appeals process?
a. 5
b. 4
c. 3
d. 2 - correct answer-d. 2
A rejected claim is?
a. A claim that has passed through the payer's initial claim processing and was determined
not to be a covered service based on coverage criteria.
b. A claim that does not contain the necessary information for adjudication.
c. Both A & B.
d. None of the above. - correct answer-b. A claim that does not contain the necessary
information for adjudication.
Which of the following includes provisions for the appeals process?
a. Patient Protection and Affordable Care Act
, b. Peer Review Improvement Act
c. Omnibus Budget Reconciliation Act
d. Federal Claims Collection Act - correct answer-a. Patient Protection and Affordable Care
Act
If a denial is received on a United healthcare claim a reconsideration must be submitted
within ____________ of the date of the EOB or RA?
a. 12 months
b. 180 days
c. 90 days
d. 60 days - correct answer-a. 12 months
Which denial occurs when the claim is a liability case and was submitted to the health
insurance?
a. Coordination of Benefits
b. Request for medical records
c. Claim not covered by insurer
d. Claim covered by other insurer - correct answer-d. Claim covered by other insurer
Significant, separately identifiable evaluation and management service by the same
physician or other qualified healthcare professional on the same day of the procedure or
other service is which modifier?
a. 50
b. 25
c. 33
d. 24 - correct answer-b. 25
When submitting an appeal to Cigna for timely filing, which of the following must be
included?
a. Original EOB
b. Completed appeal form
c. Valid proof of timely filing
d. All of the above - correct answer-d. All of the above
TEST - correct answer-TEST
Claim rejections are due to what?
a. Claims that don't meet coverage criteria
b. Claims that are already adjudicated
c. Claims that do not contain necessary information for adjudication
d. Claims that require medical record documentation - correct answer-c. Claims that do not
contain necessary information for adjudication
QUIZ - correct answer-QUIZ
Which modifier is used to indicate that an E&M service is unrelated to the global service?
a. 24
b. 25
c. 59
d. 79 - correct answer-a. 24
If a provider wishes to submit for a first level provider payment review form Cigna, what is
the timeframe for this type of dispute?
a. 60 days
b. 90 days
c. 180 days
d. 365 days - correct answer-c. 180 days
Which of the following denials is one of the leading reasons a claim is denied and can be
prevented by accurate intake information being collected every time?
a. Medical necessity
b. Coordination of Benefits
c. Request for medical records not received
d. Incorrect patient information - correct answer-d. Incorrect patient information
According to the policy, how many steps is in the Aetna dispute and appeals process?
a. 5
b. 4
c. 3
d. 2 - correct answer-d. 2
A rejected claim is?
a. A claim that has passed through the payer's initial claim processing and was determined
not to be a covered service based on coverage criteria.
b. A claim that does not contain the necessary information for adjudication.
c. Both A & B.
d. None of the above. - correct answer-b. A claim that does not contain the necessary
information for adjudication.
Which of the following includes provisions for the appeals process?
a. Patient Protection and Affordable Care Act
, b. Peer Review Improvement Act
c. Omnibus Budget Reconciliation Act
d. Federal Claims Collection Act - correct answer-a. Patient Protection and Affordable Care
Act
If a denial is received on a United healthcare claim a reconsideration must be submitted
within ____________ of the date of the EOB or RA?
a. 12 months
b. 180 days
c. 90 days
d. 60 days - correct answer-a. 12 months
Which denial occurs when the claim is a liability case and was submitted to the health
insurance?
a. Coordination of Benefits
b. Request for medical records
c. Claim not covered by insurer
d. Claim covered by other insurer - correct answer-d. Claim covered by other insurer
Significant, separately identifiable evaluation and management service by the same
physician or other qualified healthcare professional on the same day of the procedure or
other service is which modifier?
a. 50
b. 25
c. 33
d. 24 - correct answer-b. 25
When submitting an appeal to Cigna for timely filing, which of the following must be
included?
a. Original EOB
b. Completed appeal form
c. Valid proof of timely filing
d. All of the above - correct answer-d. All of the above
TEST - correct answer-TEST
Claim rejections are due to what?
a. Claims that don't meet coverage criteria
b. Claims that are already adjudicated
c. Claims that do not contain necessary information for adjudication
d. Claims that require medical record documentation - correct answer-c. Claims that do not
contain necessary information for adjudication
