NCCT Interactive Review Medical Insurance Exam 2025 | Verified Answers

NCCT Interactive Review Medical
Insurance Exam Questions With
100% Correct And Verified Answers
2025
EligibilitylforlMedicaidlmaylchangelaslquicklylasl-lCORRECT ANSWERS-
monthly.

Whichloflthelfollowinglprocesseslrequireslcheckinglandlconfirmingltha
tlthelpatientlislalmemberloflthelinsurancelplanlandlthatlthelmemberlide
ntificationlnumberlislcorrect?l-lCORRECT ANSWERS-verification

Thelpatientlislal3-year-
old.lBothlparentslhavelprivatelinsurancelcoveragelonlthelpatient,landlt
helmotherlhaslalHealthcarelSavingslAccount.lThelprimarylinsurancelbe
longsltolthelparentl-lCORRECT ANSWERS-
withlthelearlierlbirthdaylinlthelyear.

Alchildlwaslseenlbylherlpediatrician.lThelchildlislcoveredlunderlbothlhe
rlfather'slandlmother'slinsurance.lAccordingltolthel"BirthdaylRule,"lthe
lmother'slinsurancelislprimary.lWhy?l-lCORRECT ANSWERS-

Thelmother'slbirthdaylcomeslfirstlinlthelcalendarlyear.

Whichloflthelfollowinglstatementslisltruelconcerninglalcourtlorderlabo
utlchildren'slhealthlcoveragelafterlaldivorce?l-lCORRECT ANSWERS-
Divorcelrulingsloverridelthelbirthdaylrule.

Iflalmarriedlcouplelislcoveredlunderlbothlspouses'lhealthlinsurancelan
dlthelhusbandlislpickingluplalprescriptionlforlhimself,lhelshouldl-
lCORRECT ANSWERS-

uselbothloflinsurancelbenefitslasltheylapplyltolthislpharmacylpurchase.

Alpatientlhasljustlleftltheldoctor'slofficelwithlalnewlprescriptionlafterlal
scheduledlfollowluplvisit.lIflthelpatient'slprimarylinsurancelcoverslthel
billlcompletely,lherlsecondarylinsurancelpolicyl-lCORRECT ANSWERS-
willlnotlbelusedlforlthislvisit.

ThelMedicarelSecondarylPayerlQuestionnairelislalformlthatl-lCORRECT
ANSWERS-



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,patientslfillloutltoldeterminelifltherelislotherlinsuranceldesignatedlaslt
helprimarylinsurance.

Whichloflthelfollowinglshouldlthelinsurancelandlcodinglspecialistlchec
klinlorderltoldeterminelwhichlpayerlshouldlbelbilledlaslprimarylorlseco
ndary?l-lCORRECT ANSWERS-
COB:lCOBlstandslforlCoordinationloflBenefitslandldetermineslthelorderl
inlwhichlthelinsurancelspecialistlshouldlbilllthelpayers.

WhichloflthelfollowinglstatementslisltruelforlanlemployeelonlMedicareli
flhelchooseslcoveragelunderlthelemployer'slgrouplplan?l-lCORRECT
ANSWERS-
ThelgrouplplanlwilllbelprimarylandlMedicarelwilllbelsecondary.

Whichloflthelfollowingldetermineslthelprimarylpolicylifltwolplanslcoverl
aldependentlchild?l-lCORRECT ANSWERS-
Thelparentlwholhaslthelfirstlbirthdateloflthelyear.

ThelpatientlhadlUnitedlHealthlCarelHMOlgrouplinsurancelbeforelshelret
ired.lTodaylshelpresentedlherlMedicarelPartlBlinsurancelcardlandlherlh
usband'slBluelCrosslBluelShieldlPPOlgrouplinsurancelcardltolthelinsura
ncelandlcodinglspecialist.lWhichloflthelfollowinglislthelpatient'slprimar
ylinsurancelforltoday'slvisit?l-lCORRECT ANSWERS-
BluelCrosslBluelShieldlPPO:

MedicarelPartlBlislnotlprimarylwhenlthelpatientlislpartloflalgrouplspons
oredlhealthlplan.lUnitedlHealthlCarelHMOlislnotlinleffectlaslthelscenario
lindicateslthatlthelpatientl"had"lthelplan.lBluelCrosslBluelShieldlPPOlisl

primaryltolMedicarelwhenlthelpatientlislpartloflalgrouplsponsoredlhealt
hlinsurancelplanlandlwouldlbelthelcorrectlresponse.lMedicarelPartlAlw
ouldlnotlbelcorrectlbecauselitlislnotlmentionedlinlthelscenariolandlislno
tlusedlforlofficel(outpatient)lservices.

Alpatientlwaslhurtlatlworklandlseenlinlthelphysician'slofficeltoday.lThel
patientlislcoveredlunderlMedicarelandlBCBSlandlislalsolcoveredlunderl
Workers'lCompensationlforlthislinjury.lWhichloflthelfollowinglislthelpri
marylinsurancelandlthelsecondarylinsurance?l-lCORRECT ANSWERS-
Worker'slCompensationlislthelprimary,lBCBSlislthelsecondary:

ThelpatientlwaslinjuredlatlworklsolWorker'slCompensationlislthelprima
rylinsurancelcarrier.lOncelthelclaimlislprocessedlthroughlWorker'slCo
mpensation,litlwouldlfollowlthelstandardloflthelpatient'slhealthlinsura
ncelclaimlprocess.lSincelthelpatientlislworkinglandlcoveredlunderlthele



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, mployers'lpolicy,lthelclaimlshouldlbelfiledlwithlBCBSlaslthelnextlsteplofl
submissionlandlthelclaimlwouldlbelfiledlwithlMedicarellast.

Placeltheloptionslbelowlinlorderloflclaimlsubmission,lwherelalllinsuran
ceslarelrelevant.l(Clicklandldragltheloptionslinlthelleftlcolumnltoltheirlc
orrectlpositionlinlthelrightlcolumn.):lMedicare,lMedicaid,lHumana,lABCl
Autol-lCORRECT ANSWERS-ABClAuto,lHumana,lMedicare,lMedicaid:

Itlislhighlylunlikelylthatlalpatientlwouldlhavelalllfourlofltheselinsurance
s.lHowever,lifltheyldo,lthelorderlinlwhichlthelclaimslarelsubmittedlislrel
evant.lItlislassumedlthatlsinceltherelislautolinsurancelinvolved,lthatlthi
slclaimlhasltoldolwithlanlautomobilelaccident.lThelautolinsurancelshoul
dlbelfiledlfirst.lHumana,lalprivatelpayer,lshouldlbelfiledlnext.lGovernme
ntlinsurance,lsuchlaslMedicarelandlMedicaid,lshouldlalwayslbelsubmitt
edllast.lWhenlbothlMedicarelandlMedicaidlarelvalid,lMedicaidlshouldlbel
billedllast.

Afterlalpatientlislseenlforlalfollowluplvisit,lthelphysicianlordersladdition
alldiagnosticltesting.lWhichloflthelfollowingldoeslthelinsurancelandlcod
inglspecialistlneedltolobtain?l-lCORRECT ANSWERS-pre-authorization:

Albillinglandlcodinglspecialistlmustlobtainlalpre-
authorizationlforltheldiagnosticltesting.lAlpre-
authorizationlislapprovallfromlthelinsurancelcompanylforltheltestinglto
lbeldone.lAnlallowedlamountlislnotlobtainedluntillreceivinglthelexplana

tionloflbenefits,lafterlthelservicelislcompleted.lAlreferrallislneededltolse
elalspecialist,linlsomelsituations,landlislprovidedlbylthelprimarylcarelph
ysician.lAnladvancedlbeneficiarylnoticelislalstatementlthatlislsignedlbyl
thelpatientlwhenlitlislknownlthatlthelinsurancelcompanylwilllnotlpaylfo
rlthelservicelandlthelpatientlislelectingltolhavelthelservicelanyway.lItlisl
alpromiselthatlthelpatientlwilllpaylforlthelserviceslinlfull.

Alpatientlislreferredltolalspecialistlbylthelprimarylcarelprovider.lPre-
certificationlislrequiredlforlthislpatient'slspecialtylvisit.lWhichloflthelfol
lowinglactionslislrequiredlbylthelinsurancelandlcodinglspecialistltolobt
ainlauthorization?l-lCORRECT ANSWERS-
Contactlthelpatient'slinsurancelprovider:

Anlinsurancelandlcodinglspecialistlmustlobtainlanlauthorizationlforlalp
atientltolseelthelspecialist.lThislauthorizationlislobtainedlbylcontacting
lthelpatient'slinsurancelproviderlforlauthorizationlbeforelthelpatientlca

nlseelthelspecialist




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