Chapter 13 Comprehensive Exam
Questions And Answers Rated A+.
When submitting an appeal to Cigna for timely filing, which of the following is NOT required?
a.
Original EOB.
b.
Completed appeal form.
c.
Documentation to justify reversal of the decision.
d.
The patient's complete medical chart. - Answer d.
The patient's complete medical chart.
To file an appeal to Cigna, submit the original EOB, a completed appeal form, and documentation that
justifies why the decision should be reversed. Multiple forms can be found on Cigna's website for billing
dispute resolutions, appeal requests, and provider payment reviews. Some states have specific forms, so
it is always best to check your provider contract for the proper process.
If a denial is received on a United healthcare claim a reconsideration must be submitted within
____________ of the date of the EOB or RA?
a.
12 months
b.
180 days
c.
90 days
d.
,60 days - Answer a.
12 months
A reconsideration must be submitted within twelve months of the date of the EOB or RA.
Which of the following denials is one of the leading reasons a claim is denied and can be prevented by
accurate intake information being collected every time?
a.
Medical necessity
b.
Coordination of Benefits
c.
Request for medical records not received
d.
Incorrect patient information - Answer d.
Incorrect patient information
Submitting incorrect patient demographic information to the insurance payer is one of the leading
reasons a claim is rejected. Accurate intake information is imperative to avoid typographical errors.
Which modifier is used to indicate that an E&M service is unrelated to the global service?
a.
24
b.
25
c.
59
, d.
79 - Answer a.
24
Modifier 24 is an Unrelated Evaluation and Management Service by the Same Physician or Other
Qualified Healthcare Professional During a Postoperative Period.
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 - Answer c.
180 days
A first level provider payment review must be initiated within 180 calendar days from the date of the
initial payment or denial decision from Cigna.
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.
Questions And Answers Rated A+.
When submitting an appeal to Cigna for timely filing, which of the following is NOT required?
a.
Original EOB.
b.
Completed appeal form.
c.
Documentation to justify reversal of the decision.
d.
The patient's complete medical chart. - Answer d.
The patient's complete medical chart.
To file an appeal to Cigna, submit the original EOB, a completed appeal form, and documentation that
justifies why the decision should be reversed. Multiple forms can be found on Cigna's website for billing
dispute resolutions, appeal requests, and provider payment reviews. Some states have specific forms, so
it is always best to check your provider contract for the proper process.
If a denial is received on a United healthcare claim a reconsideration must be submitted within
____________ of the date of the EOB or RA?
a.
12 months
b.
180 days
c.
90 days
d.
,60 days - Answer a.
12 months
A reconsideration must be submitted within twelve months of the date of the EOB or RA.
Which of the following denials is one of the leading reasons a claim is denied and can be prevented by
accurate intake information being collected every time?
a.
Medical necessity
b.
Coordination of Benefits
c.
Request for medical records not received
d.
Incorrect patient information - Answer d.
Incorrect patient information
Submitting incorrect patient demographic information to the insurance payer is one of the leading
reasons a claim is rejected. Accurate intake information is imperative to avoid typographical errors.
Which modifier is used to indicate that an E&M service is unrelated to the global service?
a.
24
b.
25
c.
59
, d.
79 - Answer a.
24
Modifier 24 is an Unrelated Evaluation and Management Service by the Same Physician or Other
Qualified Healthcare Professional During a Postoperative Period.
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 - Answer c.
180 days
A first level provider payment review must be initiated within 180 calendar days from the date of the
initial payment or denial decision from Cigna.
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.
