QUANTUM HEALTH EXAM QUESTIONS WITH SOLUTIONS
GRADED A+ 2025/2026
The 3 different places you can find the EOB - ✔✔The internal claims system, member
website and/or TPA website
✔✔3 pieces of info we need to confirm a provider is INN - ✔✔Address, Tax ID #,
Provider's Name
✔✔Outpatient Pre-Cert Requirements - ✔✔Ordering Physician, Dx Code, CPT Code,
and Facility
✔✔OON Required Info - ✔✔Performing Physician and Facility
✔✔SBS: Sick office visit w Pediatrician - ✔✔PCP Office Visit
✔✔SBS: Lockout List Lookup - ✔✔Specialty Pharmacy
✔✔Prior to building an auth, what're 2 things you MUST confirm - ✔✔Double check if
required and/or if there's already one on file
✔✔Clinical Questions in your pod go to WHO? - ✔✔Clinical Experience Lead (CEL)
✔✔Where to find claim payment info - ✔✔EOB
✔✔Facility for Office Pre-D is always ___ - ✔✔Same as performing doctor location
✔✔Where do you look up CPTs? - ✔✔SBS
✔✔SBS: Benefits for a steroid injection done in office - ✔✔Injections
✔✔Places of Service for OP Surgery - ✔✔Surgery Center or OP Hospital
✔✔Formulary drugs can be both _____ and _____ - ✔✔Generic and name brand
✔✔Point Solution: Member Unsure of Medical Plan - ✔✔Second Opinion
✔✔What claims are processed in real time? - ✔✔Pharmacy
✔✔DME means - ✔✔Durable medical equipment
✔✔24/7 access to medical professionals via video or phone - ✔✔Telemedicine
GRADED A+ 2025/2026
The 3 different places you can find the EOB - ✔✔The internal claims system, member
website and/or TPA website
✔✔3 pieces of info we need to confirm a provider is INN - ✔✔Address, Tax ID #,
Provider's Name
✔✔Outpatient Pre-Cert Requirements - ✔✔Ordering Physician, Dx Code, CPT Code,
and Facility
✔✔OON Required Info - ✔✔Performing Physician and Facility
✔✔SBS: Sick office visit w Pediatrician - ✔✔PCP Office Visit
✔✔SBS: Lockout List Lookup - ✔✔Specialty Pharmacy
✔✔Prior to building an auth, what're 2 things you MUST confirm - ✔✔Double check if
required and/or if there's already one on file
✔✔Clinical Questions in your pod go to WHO? - ✔✔Clinical Experience Lead (CEL)
✔✔Where to find claim payment info - ✔✔EOB
✔✔Facility for Office Pre-D is always ___ - ✔✔Same as performing doctor location
✔✔Where do you look up CPTs? - ✔✔SBS
✔✔SBS: Benefits for a steroid injection done in office - ✔✔Injections
✔✔Places of Service for OP Surgery - ✔✔Surgery Center or OP Hospital
✔✔Formulary drugs can be both _____ and _____ - ✔✔Generic and name brand
✔✔Point Solution: Member Unsure of Medical Plan - ✔✔Second Opinion
✔✔What claims are processed in real time? - ✔✔Pharmacy
✔✔DME means - ✔✔Durable medical equipment
✔✔24/7 access to medical professionals via video or phone - ✔✔Telemedicine
