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Exam (elaborations)

Quantum Health Final Exam Questions With Answers

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Quantum Health Final Exam Questions With Answers

Institution
Quantum Health
Course
Quantum Health

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Quantum Health Final Exam Questions With |\ |\ |\ |\ |\ |\




Answers

The 3 different places you can find the EOB - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\


✔✔The internal claims system, member website and/or TPA
|\ |\ |\ |\ |\ |\ |\ |\ |\


website


3 pieces of info we need to confirm a provider is INN - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\


ANSWERS ✔✔Address, Tax ID #, Provider's Name
|\ |\ |\ |\ |\ |\




Outpatient Pre-Cert Requirements - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\


✔✔Ordering Physician, Dx Code, CPT Code, and Facility|\ |\ |\ |\ |\ |\ |\




OON Required Info - CORRECT ANSWERS ✔✔Performing Physician
|\ |\ |\ |\ |\ |\ |\


and Facility
|\ |\




SBS: Sick office visit w Pediatrician - CORRECT ANSWERS ✔✔PCP
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\


Office Visit |\




SBS: Lockout List Lookup - CORRECT ANSWERS ✔✔Specialty
|\ |\ |\ |\ |\ |\ |\ |\


Pharmacy


Prior to building an auth, what're 2 things you MUST confirm -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\


CORRECT ANSWERS ✔✔Double check if required and/or if there's
|\ |\ |\ |\ |\ |\ |\ |\ |\


already one on file |\ |\ |\

, Clinical Questions in your pod go to WHO? - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\


✔✔Clinical Experience Lead (CEL) |\ |\ |\




Where to find claim payment info - CORRECT ANSWERS ✔✔EOB
|\ |\ |\ |\ |\ |\ |\ |\ |\




Facility for Office Pre-D is always ___ - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\


✔✔Same as performing doctor location
|\ |\ |\ |\




Where do you look up CPTs? - CORRECT ANSWERS ✔✔SBS
|\ |\ |\ |\ |\ |\ |\ |\ |\




SBS: Benefits for a steroid injection done in office - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\


ANSWERS ✔✔Injections |\




Places of Service for OP Surgery - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\


✔✔Surgery Center or OP Hospital |\ |\ |\ |\




Formulary drugs can be both _____ and _____ - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\


ANSWERS ✔✔Generic and name brand
|\ |\ |\ |\




Point Solution: Member Unsure of Medical Plan - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\


ANSWERS ✔✔Second Opinion |\ |\




What claims are processed in real time? - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\


✔✔Pharmacy


DME means - CORRECT ANSWERS ✔✔Durable medical equipment
|\ |\ |\ |\ |\ |\ |\
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Quantum Health
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Quantum Health

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Uploaded on
July 17, 2025
Number of pages
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Written in
2024/2025
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