Which plan is primary? When a patient is covered by her employer-sponsored group plan and by a government plan (not affiliated with the employer). - THE CORRECT ANSWER IS Employer-sponsored plan
Which plan is primary?
...
Which plan is primary? When a patient is covered by her employer-sponsored group plan and by a government plan (not affiliated with the employer). - THE CORRECT ANSWER IS Employer-sponsored plan
Which plan is primary? When a patient is covered by her employer's group insurance plan and also, covered by her spouse's group plan. - THE CORRECT ANSWER IS Employer-sponsored plan
For treatment not covered by the insurance plan requires prospective authorization, otherwise known as ...? - THE CORRECT ANSWER IS Precertification
101, 102, 103 and 104 are the four Federal enrollment options and considered what ID number on BCBS Claims? - THE CORRECT ANSWER IS Group ID number
Blue Cross and Blue Shield plans originated as two separate entities selling what type of health plans? - THE CORRECT ANSWER IS Pre-paid Medical
Where did the first Blue Shield plan originate? - THE CORRECT ANSWER IS Palo Alto, California
What are special contract clauses that stipulate additional coverage for health care services? - THE CORRECT ANSWER IS Riders
Most BCBS plans policyholders are known as? - THE CORRECT ANSWER IS Members
What is the deadline for submitting, customarily? - THE CORRECT ANSWER IS One year from date of service
What clause always coverage for immediate treatment sought and received for sudden, severe, and unexpected conditions that, if left untreated, would place the patient's health in jeopardy? - THE CORRECT ANSWER IS Medical Emergency Care Rider
Hospitalization, laboratory services, x-ray services, surgical fees, assistant surgeon fees, obstetric care, intensive care, newborn care and chemotherapy are routine service covered by? - THE CORRECT ANSWER IS BCBS
What year did the American Hospital Association (AHA) become the approving agency for accreditation of new prepaid hospitalization plans? - THE CORRECT ANSWER IS 1939
What year did Blue Cross and Blue Shield merge into a single corporation called BlueCross BlueShield Association? - THE CORRECT ANSWER IS 1986
What year did Blue Cross and Blue Shield combine personnel under the leadership of a single president, responsible to both boards of directors? - THE CORRECT ANSWER IS 1977
Coordinated home health and hospice provides the member an option to elect alternatives to the _______ ______ _______? - THE CORRECT ANSWER IS Acute Care Setting
Making direct payments, conducting regular training sessions for billing staff, free billing manual, representative to assist with billing/payment problems and having the office name in a directory are all in return for ... - THE CORRECT ANSWER IS Participating Providers (Par)
An organization or corporation that returns profits, made back into the company is what type of corporation? - THE CORRECT ANSWER IS Nonprofit Corporation
What type of organization must pay taxes on the profits and then distribute a percent to all share-holders? - THE CORRECT ANSWER IS For-profit Corporation
In exchange for the tax benefits of nonprofit status, BCBS plans are forbidden to cancel policies based on which two factors? - THE CORRECT ANSWER IS Patient is in poor health and payments to providers far exceed the average
Fee-for-service (traditional coverage), Indemnity, Managed Care Plans, Federal Employee Programs, Medicare Supplemental plans and Healthcare Anywhere are all programs offered with ... - THE CORRECT ANSWER IS BCBSA
Who's name is listed on the card of the Federal Employee Program BCBS? - THE CORRECT ANSWER IS Government Employee, only
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