QUANTUM HEALTH FINAL EXAM QUESTIONS AND ANSWERS
How long does it take for pharmacy claims to process? - CORRECT ANSWER✅✅✅Immediately (Real
Time)
Why would a PCP's name in PIVIT be highlighted yellow? - CORRECT ANSWER✅✅✅needs updating
or verification
A member calls and tells you that they were just diagnosed with a serious medical condition that will
require surgery and a lot of rehab. They just want to make sure that is the best and only option that they
have. What kind of point solution would you suggest for them? - CORRECT ANSWER✅✅✅Second
opinion
What do you call a group of doctors, hospitals, and other healthcare providers that are contracted to
offer their services for a lower than usual rate - CORRECT ANSWER✅✅✅Specialty/Narrow Network
What section of Smart Benefit Search would you go to in order to quote a sick office visit with a
pediatrician - CORRECT ANSWER✅✅✅PCP- Office Visit
What does DME stand for? - CORRECT ANSWER✅✅✅durable medical equipment
In which section of SBS would you look for information on specific requirements an employee would
need to satisfy in order to get a lower premium? - CORRECT ANSWER✅✅✅Incentive Management
Program
People who have an established relationship with a PCP spend on average ____ less on healthcare -
CORRECT ANSWER✅✅✅30
When calling the network to verify whether a provider participates to not, what are the 3 pieces of
information you need to obtain before calling? - CORRECT ANSWER✅✅✅Doctor's name, Facility (
Billing address), and Tax ID
, What 3 pieces of information do we need to properly look up a claim - CORRECT ANSWER✅✅✅date
of service, amount of claim, and provider name
What are the two main functions of a TPA - CORRECT ANSWER✅✅✅Administer the plan and pay
claims
Why does an employer hire a network for their plan - CORRECT ANSWER✅✅✅To save money and
provide services at discounted (contracted) rate
When building a Pre-Determination for an office procedure, what provider will you input in the top right
hand corner of the Pre-D? (Physician/Facility field of the form) - CORRECT ANSWER✅✅✅NPI for
Preforming Facility
What Benefit would you quote for Botox Injections - CORRECT ANSWER✅✅✅Office Surgery
what kind of nurse preforms daily concurrent for inpatient members? - CORRECT ANSWER✅✅✅UR
Nurse
At Quantum, How many pieces of information are you required to get from the member or provider
prior to giving out PHI? - CORRECT ANSWER✅✅✅3
What benefit would you quote for a CPAP machine - CORRECT ANSWER✅✅✅Durable medical
equipment
What are all of the places where you can locate an EOB - CORRECT ANSWER✅✅✅-TPA (Most
Accurate)
-Member Website
-Claims wizard
On a precert, which two pieces of information make it turn green or red - CORRECT
ANSWER✅✅✅Place of service & CPT Code
How long does it take for pharmacy claims to process? - CORRECT ANSWER✅✅✅Immediately (Real
Time)
Why would a PCP's name in PIVIT be highlighted yellow? - CORRECT ANSWER✅✅✅needs updating
or verification
A member calls and tells you that they were just diagnosed with a serious medical condition that will
require surgery and a lot of rehab. They just want to make sure that is the best and only option that they
have. What kind of point solution would you suggest for them? - CORRECT ANSWER✅✅✅Second
opinion
What do you call a group of doctors, hospitals, and other healthcare providers that are contracted to
offer their services for a lower than usual rate - CORRECT ANSWER✅✅✅Specialty/Narrow Network
What section of Smart Benefit Search would you go to in order to quote a sick office visit with a
pediatrician - CORRECT ANSWER✅✅✅PCP- Office Visit
What does DME stand for? - CORRECT ANSWER✅✅✅durable medical equipment
In which section of SBS would you look for information on specific requirements an employee would
need to satisfy in order to get a lower premium? - CORRECT ANSWER✅✅✅Incentive Management
Program
People who have an established relationship with a PCP spend on average ____ less on healthcare -
CORRECT ANSWER✅✅✅30
When calling the network to verify whether a provider participates to not, what are the 3 pieces of
information you need to obtain before calling? - CORRECT ANSWER✅✅✅Doctor's name, Facility (
Billing address), and Tax ID
, What 3 pieces of information do we need to properly look up a claim - CORRECT ANSWER✅✅✅date
of service, amount of claim, and provider name
What are the two main functions of a TPA - CORRECT ANSWER✅✅✅Administer the plan and pay
claims
Why does an employer hire a network for their plan - CORRECT ANSWER✅✅✅To save money and
provide services at discounted (contracted) rate
When building a Pre-Determination for an office procedure, what provider will you input in the top right
hand corner of the Pre-D? (Physician/Facility field of the form) - CORRECT ANSWER✅✅✅NPI for
Preforming Facility
What Benefit would you quote for Botox Injections - CORRECT ANSWER✅✅✅Office Surgery
what kind of nurse preforms daily concurrent for inpatient members? - CORRECT ANSWER✅✅✅UR
Nurse
At Quantum, How many pieces of information are you required to get from the member or provider
prior to giving out PHI? - CORRECT ANSWER✅✅✅3
What benefit would you quote for a CPAP machine - CORRECT ANSWER✅✅✅Durable medical
equipment
What are all of the places where you can locate an EOB - CORRECT ANSWER✅✅✅-TPA (Most
Accurate)
-Member Website
-Claims wizard
On a precert, which two pieces of information make it turn green or red - CORRECT
ANSWER✅✅✅Place of service & CPT Code
