Senture Quantum Final Exam Questions with Answers

Senture Quantum Final Exam Questions with |\ |\ |\ |\ |\ |\




Answers

List the 3 pieces of information needed to verify a members
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identification in order to discuss PHI - CORRECT ANSWERS ✔✔1.|\ |\ |\ |\ |\ |\ |\ |\ |\ |\


ID Number
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2. Name
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3. Date of Birth
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What are the 3 places or ways to find an EOB - CORRECT
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ANSWERS ✔✔1. TPA website |\ |\ |\ |\




2. Members website
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3. Internal claim
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Define deductible - CORRECT ANSWERS ✔✔The fixed dollar
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amount that is the responsibility of the member/family to pay
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before the plan starts to pay a certain percentage.
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Define Out of pocket max - CORRECT ANSWERS ✔✔A fixed dollar
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amount that is the responsibility of the member or family to pay
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before the plan will start paying 100% of covered INN services.
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What are the 3 pieces of billing information needed to verify if
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the provider is INN - CORRECT ANSWERS ✔✔1. Billing address
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2. Billing name
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, 3. Billing TID
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When quoting benefits for OP surgery. Who are the 2 provider we
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should be checking network status on? - CORRECT ANSWERS
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✔✔1. Facility |\ |\




2. Surgeon
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When a caller is asking about a claim. What are the 3 pieces of
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information needed to most efficiently locate the claim? - |\ |\ |\ |\ |\ |\ |\ |\ |\


CORRECT ANSWERS ✔✔1. Date of Service |\ |\ |\ |\ |\ |\




2. Total Charged amount
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3. Provider name
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When building a Precert for an OP MRI. What are the 4 key items
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needed (DO NOT INCLUDE THE DOS) - CORRECT ANSWERS ✔✔1.
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CPT code |\ |\




2. Diagnosis Code
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3. Ordering Provider
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4. Facility
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name the document that outlines every detail of the plan also
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known as the "constitution of the plan" - CORRECT ANSWERS
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✔✔SPD (Summary Plan Description)
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The network that covers members when they are traveling or
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temporarily outside of their home area. - CORRECT ANSWERS |\ |\ |\ |\ |\ |\ |\ |\ |\


✔✔Wrap Network |\