Bcbs and commercial Exam Questions with Correct Answers

Bcbs and commercial Exam Questions with Correct Answers commercial health insurance - Answer-covers the medical expenses for individuals (e.g. private health insurance) and groups (e.g. employer group health insurance commercial claim - Answer-the patient is covered by a large employer group health plan (EGHP) and a patient is also a Medicare beneficiary. EGHP is primary commercial secondary coverage - Answer-if the payers for the primary and secondary or supplemental policies are different submit a CMS-1500 claim to the primary payer participating providers - Answer-the "blues" were pioneers in negotiating contracts with providers of care. A participating provider is a health care provider who enters into a contract with a BCBS corporation and agrees to preferred provider network - Answer-a program that requires providers to adhere to managed care provisions PPN provider - Answer-a provider who is signed a PPN contract) agrees to accept the PPN allowed rate , which generally ten percent lower than the PAR allowed rate. The provider further agrees to abide by all cost containment, utilization and quality assurance provisions of the PPN program. nonparticipating providers - Answer-have not signed participating provider contract, and they will expect to be paid the full fee charged for services rendered federal employee program (FEP) or federal employee health benefits program (FEHBP) - Answer-is an employer-sponsored health benefits program established by an Act of congress in 1959