WGU C428 OA EXAM ACTUAL
EXAMINATION 2026 COMPLETE 400
QUESTIONS WITH VERIFIED ANSWERS
GRADED A+
⩥ Accountable Care Organization Goal. Answer: To deliver seamless,
high-quality care instead of the fragmented care that often results from a
fee-for-service payment system.
⩥ Beneficiary. Answer: Insurers usually refer to the patient for which
services are paid
⩥ Benefit Payment. Answer: Once the insurer has determined the claim
is appropriate, a payment is made to the provider.
⩥ Bundled payments. Answer: A single prospective payment by a health
plan to all providers involved in a patients episode of care where the
providers divide the payment among themselves.
⩥ Centers for Medicare and Medicaid Services (CMS). Answer: The
federal government oversees all parts of the Medicare and Medicaid
programs through this.
, ⩥ Children's Health Insurance Program (CHIP). Answer: A joint federal-
state program that provides health-care insurance for uninsured children
up to 19 whos families do not qualify for Medicaid.
⩥ Claim. Answer: A bill for healthcare services provided.
⩥ Coinsurance. Answer: A percentage of the insurance payment amount
that is paid by the patient, along with the amount paid by the insurer.
⩥ Copay. Answer: A flat amount that a patient pays at each time of
service.
⩥ Covered benefit. Answer: The services for which the insurer will pay
are usually referred to as a covered benefit.
⩥ Deductible. Answer: A pre-determined amount that the patient pays
before the insurer begins to pay for service.
⩥ Denial. Answer: The insurer may determine that the claim from the
provider is not a covered benefit and will not pay the claim.
⩥ Employer Mandate. Answer: Requires employers with 50 or more full
time employees to offer health insurance coverage.
EXAMINATION 2026 COMPLETE 400
QUESTIONS WITH VERIFIED ANSWERS
GRADED A+
⩥ Accountable Care Organization Goal. Answer: To deliver seamless,
high-quality care instead of the fragmented care that often results from a
fee-for-service payment system.
⩥ Beneficiary. Answer: Insurers usually refer to the patient for which
services are paid
⩥ Benefit Payment. Answer: Once the insurer has determined the claim
is appropriate, a payment is made to the provider.
⩥ Bundled payments. Answer: A single prospective payment by a health
plan to all providers involved in a patients episode of care where the
providers divide the payment among themselves.
⩥ Centers for Medicare and Medicaid Services (CMS). Answer: The
federal government oversees all parts of the Medicare and Medicaid
programs through this.
, ⩥ Children's Health Insurance Program (CHIP). Answer: A joint federal-
state program that provides health-care insurance for uninsured children
up to 19 whos families do not qualify for Medicaid.
⩥ Claim. Answer: A bill for healthcare services provided.
⩥ Coinsurance. Answer: A percentage of the insurance payment amount
that is paid by the patient, along with the amount paid by the insurer.
⩥ Copay. Answer: A flat amount that a patient pays at each time of
service.
⩥ Covered benefit. Answer: The services for which the insurer will pay
are usually referred to as a covered benefit.
⩥ Deductible. Answer: A pre-determined amount that the patient pays
before the insurer begins to pay for service.
⩥ Denial. Answer: The insurer may determine that the claim from the
provider is not a covered benefit and will not pay the claim.
⩥ Employer Mandate. Answer: Requires employers with 50 or more full
time employees to offer health insurance coverage.
