Test Your Provider Auth Knowledge!

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This test is designed to evaluate your knowledge as a Provider Services Representative in handling authorization requests using NE360.

Creada por

Ash Collignon

Estados Unidos

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Test Your Provider Auth Knowledge!


Froggy Jumps Test Your Provider Auth Knowledge!Versión en línea This test is designed to evaluate your knowledge as a Provider Services Representative in handling authorization requests using NE360. por Ash Collignon 1 What is Care Managment's fax number? a 281-368-7359 b 281-368-7380 c 281-368-7382 2 Who is the head of the Care Managment team? a Melissa Muir b Kimberly Denley c Tamara Rutledge 3 What is Care Managment's ext? a 1322 b 1199 c 1318 4 What does HLOS stand for? a Hospital Level of Service b Hospital Length of Stay c Hospital Legal Oversight Standards 5 What is a Pre-Determinaton? a A review of medical necessity for a flagged service before it’s provided b A guarantee of payment for a scheduled medical service c A review of medical necessity for an inpatient admission 6 In a Billing Discount case, what does Care Management do? a Reviews requests from providers to approve services based on medical necessity b Works with providers to eliminate medical bills with a 100% gaurenteed success rate c Works with providers to reduce the amount the member owes, either before or after care 7 What is Utilization Management? a Negotiation to lower the member’s owed amount before or after care b Review to ensure services are medically necessary, covered, and meet clinical guidelines c Approval of payment and guarantee that the service will be fully covered by the plan 8 Which type of care does an HLOS cover? a Outpatient Care b Inpatient Admits c Preventive Care 9 If a Pre-Determination is approved, how is the provider notified? a Phone call b Email c Fax 10 What does an authorization approval guarantee? a Policy will be active on the date of service b Medical necessity of the service c Payment for the service 11 Who makes the final decision about payment for a claim? a Claims Department b Care Managment Team c Customer Service Department 12 When starting an auth, what is the provider required to send via fax? a Credentials b Billing Invoices c Clinicals 13 Who initiates a prior auth request? a Patient b Provider c Agent 14 What system is used to submit an auth referral? a NE360 b HBMS c PaperVision 15 What does a CSR do to start an auth? a Transfer caller to ext. 1322 b Email Care Managment c Submit a referral in NE360 16 What is the first status in the authorization case lifecycle? a Make Determination b Receive Medical Records c Notify Provider 17 When does a Care Management nurse review an auth request? a After clinical documentation is received b As soon as the referral is submitted c After the service is completed 18 What happens after a decision is made by Care Management? a The provider is notified by fax of the outcome b The case is closed immediately c The claim is automatically paid 19 For inpatient admissions, what additional info does Care Management request and review after discharge? a Discharge Summary b Itemized Bill c Test Results 20 What is a retro-HLOS? a A request to review an inpatient hospital stay after the patient has already been discharged b A request to extend a hospital stay before discharge c A request for an inpatient admission prior to hospital entry 21 What should you do before starting a new referral in NE360? a Fax benefits to the provider b Check if a referral is already on file c Send an email to Care Managment 22 What happens if you submit duplicate referrals for the same service? a Increases call audit scores b Guarantees faster approval c Wastes time and causes confusion 23 Who must initiate auth for outpaitent surgical procedures? a Physician b Facility c Patient 24 If a facility calls to start an auth for an outpatient surgery, what should you do? a Transfer the caller to Care Management b Ask them to have the physician’s office call c Enter a referral in NE360 25 If an existing referral matches a service, what should you NOT do? a Create a new referral b Provide the current status of the authorization c Inform the caller about the existing authorization on file 26 If the caller does NOT know the date of service, what should you do? a Write TBD b Refuse to proceed without a date c Ask for the caller's supervisor 27 What should you say if a case status is “Make Determination”? a “Authorization is completed.” b “We are waiting on clinicals.” c “Clinicals are in line for review.” 28 What should you ALWAYS say after giving an auth decision? a “This guarantees payment.” b “This does not guarantee payment." c "Thank you for submitting the authorization." 29 What is the auth number you can provide if asked? a 281-368-7359 b 281-386-7380 c 281-368-7358 30 What should you say if a provider doesn’t want to start an auth today? a “Please call us back when you're ready to start the pre-auth.” b “I’ll start it anyway. Please fax clinicals to 281-368-7380.” c "I am required to terminate the call immediately. Thank you and goodbye." 31 What should you say if a surgeon’s office wants benefits but doesn't want to start an auth, and none is on file? a “I can provide benefits, but there is no guarantee of benefits and a pre-d is required." b “We can’t quote benefits unless you start the auth or one is on file.” c "Please hold while I transfer you to our Care Managment team at ext. 1322." 32 Where do you go in NE360 to enter an auth? a Cases b Add Referral c Policy Lookup 33 What should you do if you’re missing required information while entering a referral? a Ask for the missing info b Make your best guess c Leave it blank 34 What Case Category do you select for an HLOS referral? a Billing Discount b Pre-Determination c Inpatient/ Outpatient 35 What Case Type must be selected for an HLOS referral? a Inpatient b Outpatient c Financial Advocacy 36 What department’s contact info is required for HLOS referrals? a Utilization Review b Registration c Insurance Verification 37 What should you do if the “Make Determination” task shows “Completed”? a Ask the provider to resend clinicals b Transfer the caller to Care Management c Click the “Outcome” tab to review the decision 38 What does “in-house” mean in the context of New Era’s provider calls? a Calls routed to a third-party vendor b Calls handled directly by New Era employees c Calls that involve scheduling house calls for patients 39 Which company does New Era partner with as their TPA? a First Health b Transparent Health Group c Care Guide 40 What is a Third-Party Administrator (TPA)? a A company that sells insurance policies b An internal department in New Era c A company that handles administrative tasks on behalf of an insurer

Test Your Provider Auth Knowledge!

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Test Your Provider Auth Knowledge!Versión en línea

por Ash Collignon

What is Care Managment's fax number?

Who is the head of the Care Managment team?

What is Care Managment's ext?

What does HLOS stand for?

What is a Pre-Determinaton?

In a Billing Discount case, what does Care Management do?

What is Utilization Management?

Which type of care does an HLOS cover?

If a Pre-Determination is approved, how is the provider notified?

What does an authorization approval guarantee?

Who makes the final decision about payment for a claim?

When starting an auth, what is the provider required to send via fax?

Who initiates a prior auth request?

What system is used to submit an auth referral?

What does a CSR do to start an auth?

What is the first status in the authorization case lifecycle?

When does a Care Management nurse review an auth request?

What happens after a decision is made by Care Management?

For inpatient admissions, what additional info does Care Management request and review after discharge?

What is a retro-HLOS?

What should you do before starting a new referral in NE360?

What happens if you submit duplicate referrals for the same service?

Who must initiate auth for outpaitent surgical procedures?

If a facility calls to start an auth for an outpatient surgery, what should you do?

If an existing referral matches a service, what should you NOT do?

If the caller does NOT know the date of service, what should you do?

What should you say if a case status is “Make Determination”?

What should you ALWAYS say after giving an auth decision?

What is the auth number you can provide if asked?

What should you say if a provider doesn’t want to start an auth today?

What should you say if a surgeon’s office wants benefits but doesn't want to start an auth, and none is on file?

Where do you go in NE360 to enter an auth?

What should you do if you’re missing required information while entering a referral?

What Case Category do you select for an HLOS referral?

What Case Type must be selected for an HLOS referral?

What department’s contact info is required for HLOS referrals?

What should you do if the “Make Determination” task shows “Completed”?

What does “in-house” mean in the context of New Era’s provider calls?

Which company does New Era partner with as their TPA?

What is a Third-Party Administrator (TPA)?