1) What does MAC stand for?  a) MAXIMUM ALLOWABLE COST  b) MARKET ALLOWED COST c) MAXIMUM ACCUMLATOR COST  d) MINIMUM ALLOWED COST 2) 1. WHAT PRICE SCHEDULE SHOULD BE ATTACHED TO AN HMO EXCHANGE (RETAL) PLAN THAT HAS MANDATORY MAIL?  a) BZCMMH R b) BZXMMH R c) BZXSTMMLH R d) BZXBRCVH R 3) WHAT PA CARRIER LIST WOULD YOU USE FOR A RELIGIOUS AFFILIATION GROUP?  a) BZPAAFF b) BZPAREL c) BZPAALLEXC d) BZPAALRLGN 4) TRUE OR FALSE: NO RX PLANS HAVE EDIT 31 TURNED OFF.  a) TRUE b) FALSE 5) EDIT 6 SHOULD BE CODED WITH ________ FOR ALL LINES OF BUSINESS a) B b) L c) Y d) Z 6) What job aid can you find coding steps for plans with Mandatory Mail? a) BCBS Job Aid- Variable Copay b) BCBS Job Aid-Maintenance c) BCBS Job Aid-Mail Saver Programs WIP d) BCBS Job Aid-Patient Pay 7) On claim number 231073923685028 the patient pay states 100%COPAY. What does this mean? a) Member will pay $0 dollar b) Member will pay 100 percent of the copay c) Member is responsible for the full cost of the drug d) Members deductible was met  8) In edit 4 these list names (BZMSPOP AND BZMSPOPG) are associated with this type of specialty pharmacy network? a) Open b) Exclusive Specialty 9) Compounds are made up of at least how many ingredients ? a) 1 b) less then 2 c) 2 10) For HMO Commercial and Exchange plans, what should the Effective Date at Edit 32 be a) 011001 b) 061023 c) 060123 d) 010101 11) BONUS: During adjudication, in what order does the "snake" go to read the edits ? a) Plan Edits 1 – 9, then skips to Plan Edit 31, then back to Plan Edits 10 – 30 and then Plan Edit 32 b) Plan Edits 1 – 3, then skips to Plan Edit 31, then back to Plan Edits 4 – 30 a c) Plan Edits 1 – 8, then skips to Plan Edit 31, then back to Plan Edits 9 – 30 and then Plan Edit 32

TMI-GENERAL KNOWLEDGE

Autor
Postavi

Top-lista

Vizualni stil

Postavke

Promijeni predložak

Vrati automatski spremljeno: ?