CBCS Insurance Eligibility Verification 2

Question 1

What is the 270/271 transaction in healthcare eligibility verification?

Accepted Answer

The HIPAA standard electronic transaction for eligibility and benefit inquiry (270) and response (271)

Answer

A form used to submit prior authorization requests

Answer

A Medicare enrollment form for new providers

Answer

The standard format for claim status inquiries

Question 2

What should be verified during insurance eligibility verification before an appointment?

Accepted Answer

Active coverage, effective dates, deductible/coinsurance/copay amounts, referral requirements, network status of provider, and coverage for the specific services planned

Answer

Only whether the patient has active insurance coverage

Answer

Only the patient's copay amount for the visit type

Answer

Insurance coverage and the patient's social security number

Question 3

What does 'coordination of benefits (COB) information' need to be confirmed during eligibility verification for a patient with two insurance plans?

Accepted Answer

Which plan is primary (pays first), which is secondary, and whether the plans coordinate to prevent duplicate payment

Answer

Whether the patient prefers to use their primary or secondary insurance

Answer

Only whether both plans cover the planned services

Answer

Whether the patient has met both plans' deductibles

Question 4

What is the Medicare Secondary Payer (MSP) rule?

Accepted Answer

Certain situations require Medicare to pay as secondary to another payer, such as employer group health plans for active workers, workers' compensation, or auto accident liability insurance

Answer

Medicare always pays as the primary payer before other insurance

Answer

Medicare only pays for services when no other insurance exists

Answer

Medicare automatically becomes the secondary payer when a patient turns 65

Question 5

What is the purpose of a voice authorization in insurance verification?

Accepted Answer

To verify coverage and obtain an authorization number from the payer over the phone when electronic verification is unavailable or inconclusive

Answer

To obtain written permission from the patient to verify their insurance

Answer

To authorize the patient to speak on behalf of the insurance company

Answer

To obtain a physician's verbal order for a service before billing

Question 6

What is the significance of the 'group number' on an insurance card?

Accepted Answer

It identifies the specific plan design and benefits package associated with an employer's group contract with the insurance company

Answer

It is the patient's individual member identification number

Answer

It indicates the insurance company's local branch office

Answer

It identifies the patient's primary care physician within the plan network