CL Meridian IL Claims Medicaid Final Version en ligne
Final review for IL Medicaid Claims Specialists.
1
What does the acronym LOB stand for?
2
From the details screen, the ________________ button will allow the specialist to view the payment history of a particular claim or claim line.
3
If a claim has more than one page, what could this indicate?
4
Clicking the "Reject Claim" button at the top of the claim header screen allows the specialist the option to reject either an entire claim or just an particular line.
5
In the State of Illinois, it is unacceptable for members to have a primary insurance along with any of Meridians insurance plans.
6
The edit "MUE" can mean either one of two things. What are the two things that this edit is asking the specialist to check?
7
The special pricing percentage for DME penny codes in the state of Illinois is _________.
8
Select the answer with the correct order of steps needed to forward a claim when forwarding to Change Healthcare, Appeals, FWA or Member Hold:
9
On a HCFA claim form, the resubmission code for a replacement claim is what number?
10
A Place of Service (POS) of 11 on a HCFA 1500 claim form means the services were rendered in a home setting.
11
SASS claims pay under Medicaid. If an specialist comes across a SASS claim and the line of business is selected as Medicare, the specialist is to change the line of business to Medicaid and process the claim
12
In the state of Illinois, the administration code of a drug/ vaccine always pays out individually
13
What is the maximum allowed in regards to a child's vision hardware benefits?
14
In order to reverse a paid claim, the specialist would select
15
When the CSECT edit flags on a C-SECT procedure code, how would you proceed?
16
What does HFS stand for?
17
What does CMS stand for?
18
Which folder in MCS would you look up a code to see what the maximum allowed amount of that code is
19
What does DME stand for?
20
Anesthesia claims must be billed with a _____ modifier.
21
What modifier represents physical therapy?
22
This modifier represents a service is bilateral payable.
23
When filling in transportation data, always round up the number of mileage in the system
24
A provider bills with a DME penny code item. The charge for that item is $700.45 and the invoice included with that claim has a cost amount of $465.40. If this claim was manually priced with the correct percentage for IL what would be the payment amount for that item?
25
What does the acronym MCS stand for?
26
The service location dictates the payment rate that goes out on a T1015 encounter claim
27
If a DME item or claim pays this amount or more an authorization is required regardless if AUPRC flags or if the CBT shows no PA required.
28
What does LMP stand for?
29
A newborn babies charges may be billed under the mother's member ID.
30
A _______ _______ is a claim that has been received with no errors and the system accepts it for reimbursement and therefore has no edits to be worked.
31
A DME item that is a penny code where the billed amount is under $100 is paid at this percentage.
32
Choose all of the following that are examples of a claims status that can be seen in MCS
Choose one or more answers
33
A vendor add request is assigned from the:
34
A provider bills a penny code for a DME item and charge amount billed on the claim is $85. This claim can be paid without an invoice.
35
EOBNC can be used when the provider did not send the denial reason from the primary insurance or when a multi-line HCFA claim has an EOP attached that does not show a line by line break down
36
Which edit stands for "Resubmit with a copy of the Primary Insurnace Voucher"?
37
Speech therapy requires authorization submitted to whom?
38
Select all that are true about Illinois timely filing rules
39
What are the benefit rules for Physical and Occupational Therapy?
Choose one or more answers
40
Which claim type(s) are excluded from TPL rules? Select all that apply:
Choose one or more answers
41
Waiver/homemaker claims are the only exception to when a claim does not need a taxonomy code listed on it.
|
Spanish alphabet, listening-based assessment