NCCT Review | Medical Insurance Revised Test 2023.

NCCT Review | Medical Insurance Revised Test 2023.Place the options below in order of claim submission, where all insurances are relevant. Humana ABC Auto Medicaid Medicare - ANSWER ABC Auto Humana Medicare Medicaid It is highly unlikely that a patient would have all four of these insurances. However, if they do, the order in which the claims are submitted is relevant. It is assumed that since there is auto insurance involved, that this claim has to do with an automobile accident. The auto insurance should be filed first. Humana, a private payer, should be filed next. Government insurance, such as Medicare and Medicaid, should always be submitted last. When both Medicare and Medicaid are valid, Medicaid should be billed last. Eligibility for Medicaid may change as quickly as A. daily. B. weekly. C. monthly. D. yearly. - ANSWER C. monthly. Medicaid coverage determination is monthly. For example, if a person is eligible for coverage on April 2, they are also eligible for coverage on April 25. Eligibility will not change more or less frequently than monthly. Which of the following processes requires checking and confirming that the patient is a member of the insurance plan and that the member identification number is correct? A. precertification B. prior authorization C. verification D. referral - ANSWER C. verification The process of insurance verification is the confirmation that the patient is a member of the insurance plan and that the member identification number is correct. This process should be done every time the patient comes to the office, as insurance can change at any time. Precertification is obtained for particular services and is obtained from the insurance company prior to those services being rendered. Precertification has to do with medical necessity if it is deemed that the patient's diagnosis is a proper reason to have a service. Prior authorization is the approval from the insurance company to provide a service. A referral is required for some patients to see a specialist. Not all insurance policies require referrals. The patient is a 3-year-old. Both parents have private insurance coverage on the patient, and the mother has a Healthcare Savings Account. The primary insurance belongs to the parent A. who was born first (oldest). B. with the Healthcare Savings Account. C. with the earlier birthday in the year. D. with the best insurance benefit coverage. - ANSWER C. with the earlier birthday in the year.