QUANTUM HEALTH FINAL EVALUATION EXAM QUESTIONS
WITH SOLUTIONS GRADED A+ 2025/2026
✔✔When building a precept for an OUTPATIENT SURGERY, what are the only 2
possible correct choices for the place of service dropdown portion of the precert -
✔✔Ambulatory Surgical Center [24] & OP Hospital Surgery [22E]
✔✔What is a EAP - ✔✔Employee Assistance Program
✔✔When might an out of network pay as in exemption be approved? - ✔✔No network,
Emergency Situations, No control, and Glogist rule
✔✔What does U and C stand for - ✔✔Usual & Customary
✔✔Which savings account is funded by both the employer and the member to help pay
for healthcare costs - ✔✔HSA- Health Savings Account
✔✔What network covers members when they are traveling temporarily outside of their
primary network area - ✔✔Wrap/Travel Network
✔✔What is a CPT code? - ✔✔procedure code
✔✔When quoting benefits for outpatient surgery, who are the two providers that we
should be verifying network status on before quoting - ✔✔preforming & facility
✔✔Where would you look to find out who a claim payment was sent to - ✔✔EOB
✔✔When patients self-refer, what percentage of time do they refer themselves to the
wrong specialty - ✔✔60
✔✔what section of Smart Benefit Search would you go to, to look for additional
information for extra plan offerings that employers will add to their plans to enhance
their overall coverage - ✔✔Vendors/ Point Solutions
✔✔When building a precert for an outpatient MRI, what are the 4 key items we need to
ask for? (do not include date of service) - ✔✔-ordering/preforming
-Facility (Place of Service)
-DX code
-CPT code
✔✔What section of Smart Benefit Search would you go to for benefits if the member
was having a vasectomy done in the office - ✔✔Vasectomy (Sterilization)
, ✔✔Which point solution is pricing transparency tool that allows members to compare
prices and "shop" to find the best value for varying medical procedures, facilities, and
physicians - ✔✔Healthcare Bluebook
✔✔Define deductible - ✔✔the amount an individual must pay for health care expenses
before insurance covers the cost.
✔✔Define out-of-pocket maximum - ✔✔the maximum dollar amount a member will pay
before plan pays 100% (INN)
✔✔What document outlines every detail of the plan and is known as the "constitution" of
the plan - ✔✔SPD ( Summary Plan Description)
✔✔What items can a Care Coordinator update in PIVIT - ✔✔Phone #, email, PCP, COB
✔✔If a member calls and asks us to find a mental health provider for them and in the
process of searching they start talking about wanting to "end it all" what do you do? -
✔✔Place call on MUTE & Ask for nurse ASAP!
✔✔To increase a member's participation and ownership of their health some plans offer
- ✔✔incentives
✔✔Drugs on the formulary can be both ____ and _____ medications - ✔✔brand name
& generic
✔✔What privacy regulation permits covered entities to use and disclose PHI -
✔✔HIPPA
✔✔Why is a referral important - ✔✔Real Time Intercept and to ensure that the member
is receiving the highest quality of care
✔✔What network gives the member their best benefit level - ✔✔Primary
✔✔What disease could our member have if they are seeing an oncologist - ✔✔Cancer
✔✔Which point solution provides the member with 24/7 access to doctors through
phone or video consult - ✔✔Telemedicine
✔✔A fixed dollar amount that is the responsibility of the patient at the time of service is
a(n) - ✔✔copay
✔✔If you are in the POD and have a clinical question, you would first ask which nurse?
- ✔✔CTL( Clinical Team Lead)
WITH SOLUTIONS GRADED A+ 2025/2026
✔✔When building a precept for an OUTPATIENT SURGERY, what are the only 2
possible correct choices for the place of service dropdown portion of the precert -
✔✔Ambulatory Surgical Center [24] & OP Hospital Surgery [22E]
✔✔What is a EAP - ✔✔Employee Assistance Program
✔✔When might an out of network pay as in exemption be approved? - ✔✔No network,
Emergency Situations, No control, and Glogist rule
✔✔What does U and C stand for - ✔✔Usual & Customary
✔✔Which savings account is funded by both the employer and the member to help pay
for healthcare costs - ✔✔HSA- Health Savings Account
✔✔What network covers members when they are traveling temporarily outside of their
primary network area - ✔✔Wrap/Travel Network
✔✔What is a CPT code? - ✔✔procedure code
✔✔When quoting benefits for outpatient surgery, who are the two providers that we
should be verifying network status on before quoting - ✔✔preforming & facility
✔✔Where would you look to find out who a claim payment was sent to - ✔✔EOB
✔✔When patients self-refer, what percentage of time do they refer themselves to the
wrong specialty - ✔✔60
✔✔what section of Smart Benefit Search would you go to, to look for additional
information for extra plan offerings that employers will add to their plans to enhance
their overall coverage - ✔✔Vendors/ Point Solutions
✔✔When building a precert for an outpatient MRI, what are the 4 key items we need to
ask for? (do not include date of service) - ✔✔-ordering/preforming
-Facility (Place of Service)
-DX code
-CPT code
✔✔What section of Smart Benefit Search would you go to for benefits if the member
was having a vasectomy done in the office - ✔✔Vasectomy (Sterilization)
, ✔✔Which point solution is pricing transparency tool that allows members to compare
prices and "shop" to find the best value for varying medical procedures, facilities, and
physicians - ✔✔Healthcare Bluebook
✔✔Define deductible - ✔✔the amount an individual must pay for health care expenses
before insurance covers the cost.
✔✔Define out-of-pocket maximum - ✔✔the maximum dollar amount a member will pay
before plan pays 100% (INN)
✔✔What document outlines every detail of the plan and is known as the "constitution" of
the plan - ✔✔SPD ( Summary Plan Description)
✔✔What items can a Care Coordinator update in PIVIT - ✔✔Phone #, email, PCP, COB
✔✔If a member calls and asks us to find a mental health provider for them and in the
process of searching they start talking about wanting to "end it all" what do you do? -
✔✔Place call on MUTE & Ask for nurse ASAP!
✔✔To increase a member's participation and ownership of their health some plans offer
- ✔✔incentives
✔✔Drugs on the formulary can be both ____ and _____ medications - ✔✔brand name
& generic
✔✔What privacy regulation permits covered entities to use and disclose PHI -
✔✔HIPPA
✔✔Why is a referral important - ✔✔Real Time Intercept and to ensure that the member
is receiving the highest quality of care
✔✔What network gives the member their best benefit level - ✔✔Primary
✔✔What disease could our member have if they are seeing an oncologist - ✔✔Cancer
✔✔Which point solution provides the member with 24/7 access to doctors through
phone or video consult - ✔✔Telemedicine
✔✔A fixed dollar amount that is the responsibility of the patient at the time of service is
a(n) - ✔✔copay
✔✔If you are in the POD and have a clinical question, you would first ask which nurse?
- ✔✔CTL( Clinical Team Lead)
