QUANTUM HEALTH- FINAL EXAM
QUESTIONS WITH COMPLETE
ANSWERS
How xxlong xxdoes xxit xxtake xxfor xxpharmacy xxclaims xxto xxprocess? xx- xxAnswer
xxImmediately xx(Real xxTime)
Why xxwould xxa xxPCP's xxname xxin xxPIVIT xxbe xxhighlighted xxyellow? xx- xxAnswer
xxneeds xxupdating xxor xxverification
A xxmember xxcalls xxand xxtells xxyou xxthat xxthey xxwere xxjust xxdiagnosed xxwith xxa
xxserious xxmedical xxcondition xxthat xxwill xxrequire xxsurgery xxand xxa xxlot xxof xxrehab.
xxThey xxjust xxwant xxto xxmake xxsure xxthat xxis xxthe xxbest xxand xxonly xxoption xxthat
xxthey xxhave. xxWhat xxkind xxof xxpoint xxsolution xxwould xxyou xxsuggest xxfor xxthem? xx-
xxAnswer xxSecond xxopinion
What xxdo xxyou xxcall xxa xxgroup xxof xxdoctors, xxhospitals, xxand xxother xxhealthcare
xxproviders xxthat xxare xxcontracted xxto xxoffer xxtheir xxservices xxfor xxa xxlower xxthan
xxusual xxrate xx- xxAnswer xxSpecialty/Narrow xxNetwork
What xxsection xxof xxSmart xxBenefit xxSearch xxwould xxyou xxgo xxto xxin xxorder xxto
xxquote xxa xxsick xxoffice xxvisit xxwith xxa xxpediatrician xx- xxAnswer xxPCP- xxOffice xxVisit
What xxdoes xxDME xxstand xxfor? xx- xxAnswer xxdurable xxmedical xxequipment
In xxwhich xxsection xxof xxSBS xxwould xxyou xxlook xxfor xxinformation xxon xxspecific
xxrequirements xxan xxemployee xxwould xxneed xxto xxsatisfy xxin xxorder xxto xxget xxa xxlower
xxpremium? xx- xxAnswer xxIncentive xxManagement xxProgram
People xxwho xxhave xxan xxestablished xxrelationship xxwith xxa xxPCP xxspend xxon
xxaverage xx____ xxless xxon xxhealthcare xx- xxAnswer xx30
When xxcalling xxthe xxnetwork xxto xxverify xxwhether xxa xxprovider xxparticipates xxto xxnot,
xxwhat xxare xxthe xx3 xxpieces xxof xxinformation xxyou xxneed xxto xxobtain xxbefore xxcalling?
xx- xxAnswer xxDoctor's xxname, xxFacility xx( xxBilling xxaddress), xxand xxTax xxID
, What xx3 xxpieces xxof xxinformation xxdo xxwe xxneed xxto xxproperly xxlook xxup xxa xxclaim xx-
xxAnswer xxdate xxof xxservice, xxamount xxof xxclaim, xxand xxprovider xxname
What xxare xxthe xxtwo xxmain xxfunctions xxof xxa xxTPA xx- xxAnswer xxAdminister xxthe
xxplan xxand xxpay xxclaims
Why xxdoes xxan xxemployer xxhire xxa xxnetwork xxfor xxtheir xxplan xx- xxAnswer xxTo xxsave
xxmoney xxand xxprovide xxservices xxat xxdiscounted xx(contracted) xxrate
When xxbuilding xxa xxPre-Determination xxfor xxan xxoffice xxprocedure, xxwhat xxprovider
xxwill xxyou xxinput xxin xxthe xxtop xxright xxhand xxcorner xxof xxthe xxPre-D?
xx(Physician/Facility xxfield xxof xxthe xxform) xx- xxAnswer xxNPI xxfor xxPreforming xxFacility
What xxBenefit xxwould xxyou xxquote xxfor xxBotox xxInjections xx- xxAnswer xxOffice
xxSurgery
what xxkind xxof xxnurse xxpreforms xxdaily xxconcurrent xxfor xxinpatient xxmembers? xx-
xxAnswer xxUR xxNurse
At xxQuantum, xxHow xxmany xxpieces xxof xxinformation xxare xxyou xxrequired xxto xxget
xxfrom xxthe xxmember xxor xxprovider xxprior xxto xxgiving xxout xxPHI? xx- xxAnswer xx3
What xxbenefit xxwould xxyou xxquote xxfor xxa xxCPAP xxmachine xx- xxAnswer xxDurable
xxmedical xxequipment
What xxare xxall xxof xxthe xxplaces xxwhere xxyou xxcan xxlocate xxan xxEOB xx- xxAnswer xx-
TPA xx(Most xxAccurate)
-Member xxWebsite xx
-Claims xxwizard
On xxa xxprecert, xxwhich xxtwo xxpieces xxof xxinformation xxmake xxit xxturn xxgreen xxor xxred
xx- xxAnswer xxPlace xxof xxservice xx& xxCPT xxCode
Member xxis xxcalling xxlate xxon xxa xxFriday xxnight xxand xxthey xxtell xxyou xxthat xxthey
xxthink xxthey xxhave xxpink xxeye xxbut xxtheir xxPCP xxis xxclosed xxfor xxthe xxweekend.
xxThey xxwant xxto xxknow xxwhere xxthey xxcan xxgo xxto xxget xxtreatment. xxWhat xxtype xxof
xxpoint xxsolution xxwould xxyou xxlook xxfor xxto xxeducate xxthem xxabout xx- xxAnswer
xxTelemedicine
When xxbuilding xxa xxprecept xxfor xxan xxOUTPATIENT xxSURGERY, xxwhat xxare xxthe
xxonly xx2 xxpossible xxcorrect xxchoices xxfor xxthe xxplace xxof xxservice xxdropdown xxportion
xxof xxthe xxprecert xx- xxAnswer xxAmbulatory xxSurgical xxCenter xx[24] xx& xxOP xxHospital
xxSurgery xx[22E]
What xxis xxa xxEAP xx- xxAnswer xxEmployee xxAssistance xxProgram
QUESTIONS WITH COMPLETE
ANSWERS
How xxlong xxdoes xxit xxtake xxfor xxpharmacy xxclaims xxto xxprocess? xx- xxAnswer
xxImmediately xx(Real xxTime)
Why xxwould xxa xxPCP's xxname xxin xxPIVIT xxbe xxhighlighted xxyellow? xx- xxAnswer
xxneeds xxupdating xxor xxverification
A xxmember xxcalls xxand xxtells xxyou xxthat xxthey xxwere xxjust xxdiagnosed xxwith xxa
xxserious xxmedical xxcondition xxthat xxwill xxrequire xxsurgery xxand xxa xxlot xxof xxrehab.
xxThey xxjust xxwant xxto xxmake xxsure xxthat xxis xxthe xxbest xxand xxonly xxoption xxthat
xxthey xxhave. xxWhat xxkind xxof xxpoint xxsolution xxwould xxyou xxsuggest xxfor xxthem? xx-
xxAnswer xxSecond xxopinion
What xxdo xxyou xxcall xxa xxgroup xxof xxdoctors, xxhospitals, xxand xxother xxhealthcare
xxproviders xxthat xxare xxcontracted xxto xxoffer xxtheir xxservices xxfor xxa xxlower xxthan
xxusual xxrate xx- xxAnswer xxSpecialty/Narrow xxNetwork
What xxsection xxof xxSmart xxBenefit xxSearch xxwould xxyou xxgo xxto xxin xxorder xxto
xxquote xxa xxsick xxoffice xxvisit xxwith xxa xxpediatrician xx- xxAnswer xxPCP- xxOffice xxVisit
What xxdoes xxDME xxstand xxfor? xx- xxAnswer xxdurable xxmedical xxequipment
In xxwhich xxsection xxof xxSBS xxwould xxyou xxlook xxfor xxinformation xxon xxspecific
xxrequirements xxan xxemployee xxwould xxneed xxto xxsatisfy xxin xxorder xxto xxget xxa xxlower
xxpremium? xx- xxAnswer xxIncentive xxManagement xxProgram
People xxwho xxhave xxan xxestablished xxrelationship xxwith xxa xxPCP xxspend xxon
xxaverage xx____ xxless xxon xxhealthcare xx- xxAnswer xx30
When xxcalling xxthe xxnetwork xxto xxverify xxwhether xxa xxprovider xxparticipates xxto xxnot,
xxwhat xxare xxthe xx3 xxpieces xxof xxinformation xxyou xxneed xxto xxobtain xxbefore xxcalling?
xx- xxAnswer xxDoctor's xxname, xxFacility xx( xxBilling xxaddress), xxand xxTax xxID
, What xx3 xxpieces xxof xxinformation xxdo xxwe xxneed xxto xxproperly xxlook xxup xxa xxclaim xx-
xxAnswer xxdate xxof xxservice, xxamount xxof xxclaim, xxand xxprovider xxname
What xxare xxthe xxtwo xxmain xxfunctions xxof xxa xxTPA xx- xxAnswer xxAdminister xxthe
xxplan xxand xxpay xxclaims
Why xxdoes xxan xxemployer xxhire xxa xxnetwork xxfor xxtheir xxplan xx- xxAnswer xxTo xxsave
xxmoney xxand xxprovide xxservices xxat xxdiscounted xx(contracted) xxrate
When xxbuilding xxa xxPre-Determination xxfor xxan xxoffice xxprocedure, xxwhat xxprovider
xxwill xxyou xxinput xxin xxthe xxtop xxright xxhand xxcorner xxof xxthe xxPre-D?
xx(Physician/Facility xxfield xxof xxthe xxform) xx- xxAnswer xxNPI xxfor xxPreforming xxFacility
What xxBenefit xxwould xxyou xxquote xxfor xxBotox xxInjections xx- xxAnswer xxOffice
xxSurgery
what xxkind xxof xxnurse xxpreforms xxdaily xxconcurrent xxfor xxinpatient xxmembers? xx-
xxAnswer xxUR xxNurse
At xxQuantum, xxHow xxmany xxpieces xxof xxinformation xxare xxyou xxrequired xxto xxget
xxfrom xxthe xxmember xxor xxprovider xxprior xxto xxgiving xxout xxPHI? xx- xxAnswer xx3
What xxbenefit xxwould xxyou xxquote xxfor xxa xxCPAP xxmachine xx- xxAnswer xxDurable
xxmedical xxequipment
What xxare xxall xxof xxthe xxplaces xxwhere xxyou xxcan xxlocate xxan xxEOB xx- xxAnswer xx-
TPA xx(Most xxAccurate)
-Member xxWebsite xx
-Claims xxwizard
On xxa xxprecert, xxwhich xxtwo xxpieces xxof xxinformation xxmake xxit xxturn xxgreen xxor xxred
xx- xxAnswer xxPlace xxof xxservice xx& xxCPT xxCode
Member xxis xxcalling xxlate xxon xxa xxFriday xxnight xxand xxthey xxtell xxyou xxthat xxthey
xxthink xxthey xxhave xxpink xxeye xxbut xxtheir xxPCP xxis xxclosed xxfor xxthe xxweekend.
xxThey xxwant xxto xxknow xxwhere xxthey xxcan xxgo xxto xxget xxtreatment. xxWhat xxtype xxof
xxpoint xxsolution xxwould xxyou xxlook xxfor xxto xxeducate xxthem xxabout xx- xxAnswer
xxTelemedicine
When xxbuilding xxa xxprecept xxfor xxan xxOUTPATIENT xxSURGERY, xxwhat xxare xxthe
xxonly xx2 xxpossible xxcorrect xxchoices xxfor xxthe xxplace xxof xxservice xxdropdown xxportion
xxof xxthe xxprecert xx- xxAnswer xxAmbulatory xxSurgical xxCenter xx[24] xx& xxOP xxHospital
xxSurgery xx[22E]
What xxis xxa xxEAP xx- xxAnswer xxEmployee xxAssistance xxProgram
