CPBS - CHAPTER 13
A rejected claim is?
A claim that does not contain the necessary information for adjudication.
B A claim that has passed through the payer's initial claim processing and was determined
not to be a covered service based on coverage criteria.
C Both A & B.
D None of the above. - correct answer-B A claim that has passed through the payer's initial
claim processing and was determined not to be a covered service based on coverage
criteria.
If a provider wishes to submit for a first level provider payment review form Cigna what is the
timeframe for this type of dispute?
A 60 days
B 90 days
C 180 days
D 365 days - correct answer-C 180 days
According to the policy, how many steps is in the Aetna dispute and appeals process?
A5
B4
C3
D 2 - correct answer-D 2
Which denial occurs when the claim is a liability case and was submitted to the health
insurance?
A Coordination of Benefits
B Request for medical records
C Claim not covered by insurer
D Claim covered by other insurer - correct answer-D Claim covered by other insurer
A claim reported with ICD-10-CM code S31.40 is denied for an invalid ICD-10-CM code.
What action should the biller take?
A Call the insurance carrier, S31.40 is a valid ICD-10-CM code.
B S31.40 requires an additional character, pull the medical record or query the provider for
the correct code. Submit the claim with the appropriate six-character code.
C S31.40 requires an additional character, pull the medical record or query the provider for
the correct code. Submit the claim with the appropriate sevencharacter code.
D S31.40 is for an injury and is not covered. - correct answer-C S31.40 requires an
additional character, pull the medical record or query the provider for the correct code.
Submit the claim with the appropriate seven character code.
A rejected claim is?
A claim that does not contain the necessary information for adjudication.
B A claim that has passed through the payer's initial claim processing and was determined
not to be a covered service based on coverage criteria.
C Both A & B.
D None of the above. - correct answer-B A claim that has passed through the payer's initial
claim processing and was determined not to be a covered service based on coverage
criteria.
If a provider wishes to submit for a first level provider payment review form Cigna what is the
timeframe for this type of dispute?
A 60 days
B 90 days
C 180 days
D 365 days - correct answer-C 180 days
According to the policy, how many steps is in the Aetna dispute and appeals process?
A5
B4
C3
D 2 - correct answer-D 2
Which denial occurs when the claim is a liability case and was submitted to the health
insurance?
A Coordination of Benefits
B Request for medical records
C Claim not covered by insurer
D Claim covered by other insurer - correct answer-D Claim covered by other insurer
A claim reported with ICD-10-CM code S31.40 is denied for an invalid ICD-10-CM code.
What action should the biller take?
A Call the insurance carrier, S31.40 is a valid ICD-10-CM code.
B S31.40 requires an additional character, pull the medical record or query the provider for
the correct code. Submit the claim with the appropriate six-character code.
C S31.40 requires an additional character, pull the medical record or query the provider for
the correct code. Submit the claim with the appropriate sevencharacter code.
D S31.40 is for an injury and is not covered. - correct answer-C S31.40 requires an
additional character, pull the medical record or query the provider for the correct code.
Submit the claim with the appropriate seven character code.
