UHC CERTIFICATION EXAM 2026 — 100
MULTIPLE-CHOICE QUESTIONS (WITH
ANSWERS MARKED )
1. What is the primary goal of UnitedHealthcare’s Medicare Advantage plans?
A. Reduce provider workload
B. Deliver coordinated, cost-effective care to members
C. Replace Medicaid benefits
D. Increase hospital utilization
2. Which type of plan combines Medicare Part A, Part B, and often Part D?
A. Medicare Advantage (Part C)
B. Medicaid waiver
C. Employer group plan
D. TRICARE
3. What must providers verify before delivering non-emergency services?
A. Member's tax records
B. Member’s coverage and eligibility
C. Member’s social history
D. Past zip code
4. What does UHC use to reduce gaps in care?
A. Random letters
B. Health risk assessments
C. Clinical programs & preventive reminders
D. Manual billing audits
,5. Which organization accredits UHC quality standards?
A. NBA
B. NCQA
C. FDA
D. IRS
6. What is the UHC preferred method of claims submission?
A. Fax
B. Paper mail
C. Electronic claims (EDI)
D. Phone
7. What form is used for professional claims?
A. UB-04
B. CMS-1500
C. W-2
D. DD-214
8. What must providers obtain for certain high-cost services?
A. A tax credit
B. Member consent only
C. Prior authorization
D. Retroactive override
9. When must UHC be notified of inpatient admissions?
A. 14 days
B. 7 days
C. 24–48 hours
D. 60 days
, 10. UHC's fraud, waste & abuse policy requires reporting:
A. Within 10 years
B. Within 30 days
C. Immediately
D. Only if $5,000+ is involved
11. What is a common example of fraud?
A. Wrong date of birth
B. Billing for services not rendered
C. Missing signature
D. Wrong tax ID
12. UHC appeals must be filed within:
A. 365 days
B. 30–60 days
C. 3 days
D. 10 years
13. What is the primary purpose of risk adjustment?
A. Penalize providers
B. Adjust payments based on patient complexity
C. Lower member premiums
D. Track marketing materials
14. Which document outlines member rights & responsibilities?
A. Member ID card
B. Evidence of Coverage (EOC)
C. Tax return
D. Prior authorization list
MULTIPLE-CHOICE QUESTIONS (WITH
ANSWERS MARKED )
1. What is the primary goal of UnitedHealthcare’s Medicare Advantage plans?
A. Reduce provider workload
B. Deliver coordinated, cost-effective care to members
C. Replace Medicaid benefits
D. Increase hospital utilization
2. Which type of plan combines Medicare Part A, Part B, and often Part D?
A. Medicare Advantage (Part C)
B. Medicaid waiver
C. Employer group plan
D. TRICARE
3. What must providers verify before delivering non-emergency services?
A. Member's tax records
B. Member’s coverage and eligibility
C. Member’s social history
D. Past zip code
4. What does UHC use to reduce gaps in care?
A. Random letters
B. Health risk assessments
C. Clinical programs & preventive reminders
D. Manual billing audits
,5. Which organization accredits UHC quality standards?
A. NBA
B. NCQA
C. FDA
D. IRS
6. What is the UHC preferred method of claims submission?
A. Fax
B. Paper mail
C. Electronic claims (EDI)
D. Phone
7. What form is used for professional claims?
A. UB-04
B. CMS-1500
C. W-2
D. DD-214
8. What must providers obtain for certain high-cost services?
A. A tax credit
B. Member consent only
C. Prior authorization
D. Retroactive override
9. When must UHC be notified of inpatient admissions?
A. 14 days
B. 7 days
C. 24–48 hours
D. 60 days
, 10. UHC's fraud, waste & abuse policy requires reporting:
A. Within 10 years
B. Within 30 days
C. Immediately
D. Only if $5,000+ is involved
11. What is a common example of fraud?
A. Wrong date of birth
B. Billing for services not rendered
C. Missing signature
D. Wrong tax ID
12. UHC appeals must be filed within:
A. 365 days
B. 30–60 days
C. 3 days
D. 10 years
13. What is the primary purpose of risk adjustment?
A. Penalize providers
B. Adjust payments based on patient complexity
C. Lower member premiums
D. Track marketing materials
14. Which document outlines member rights & responsibilities?
A. Member ID card
B. Evidence of Coverage (EOC)
C. Tax return
D. Prior authorization list
