Question 1

What is the most common method to handle health care claim transmission?

Accepted Answer

A)   hire clearinghouses
B)   file 837P
C)   use a remittance advice
D)   use bulk mailE) C) and D)
F) All of the above

Question 2

The part of the HIPAA claim contains information about the payer to whom the claim is going to be sent, called the

Accepted Answer

A)   destination payer
B)   primary payer
C)   secondary payer
D)   guarantorE) A) and B)
F) A) and C)

Question 3

What does a place of service (POS)  code describe about a service provided?

Accepted Answer

A)   office number
B)   hospital room
C)   location
D)   none of theseE) A) and B)
F) None of the above

Question 4

Which is not a major method of transmitting claims electronically?

Accepted Answer

A)   clearinghouse
B)   e-mail
C)   direct transmission
D)   direct data entryE) B) and C)
F) A) and D)

Question 5

What code is used to indicate whether a claim is an original, replacement, or voided code?

Accepted Answer

A)   claim frequency code
B)   claim submission reason code
C)   claim filing indictor code
D)   both claim frequency code and claim submission reason codeE) A) and B)
F) C) and D) D

Question 6

In the direct claims transmission approach, which formatting rules should the provider follow?

Accepted Answer

A)   DDE
B)   POS
C)   PHI
D)   EDIE) None of the above
F) B) and C)

Question 7

The NUCC can be expected to continue to update what form?

Accepted Answer

A)   CMS-75 form
B)   Medicaid form
C)   NUCC form
D)   CMS-1500 formE) A) and B)
F) None of the above

Question 8

A unique number assigned by the sender to each service line is a

Accepted Answer

A)   claim control number
B)   patient number
C)   line item control number
D)   none of theseE) B) and C)
F) None of the above

Question 9

With a few exceptions, the electronic claim is the same as __________.

Accepted Answer

A)   clearinghouse form
B)   paper form
C)   HCFA-1500
D)   HCPCS formE) A) and D)
F) A) and C)

Question 10

The letters "SOF" on a claim mean

Accepted Answer

A)   software used
B)   signature on file
C)   service on form
D)   none of theseE) A) and B)
F) A) and C)

Question 11

The carrier block on the CMS 1500 form is for

Accepted Answer

A)   the payer ID
B)   a section on the CMS-1500 for payer name and address
C)   a section on the CMS-1500 for the payer's NPI
D)   None of theseE) C) and D)
F) B) and D)

Question 12

The term service line information describes section 24 of the CMS-1500 claim, which reports

Accepted Answer

A)   the rendering provider
B)   procedures performed for the patient
C)   patient transactions
D)   taxonomy codesE) A) and B)
F) B) and D)

Question 13

The claim frequency code is sometimes known as the

Accepted Answer

A)   claim adjudication number
B)   claim submission reason code
C)   provider number
D)   None of theseE) C) and D)
F) All of the above

Question 14

Which types of claims are generally used for reporting physicians' services?

Accepted Answer

A)   paper claims
B)   HIPAA claim
C)   both paper claims and HIPAA claims
D)   neither paper claims nor HIPAA claimsE) A) and D)
F) A) and C)

Question 15

If a paper RA is received, what should be sent to the secondary health plan?

Accepted Answer

A)   CMS-1500
B)   RA
C)   medical records
D)   both the CMS-1500 and the RAE) None of the above
F) A) and B)

Question 16

The organization or person transmitting the claim to the payer is the

Accepted Answer

A)   billing provider
B)   pay-to provider
C)   physician
D)   patientE) A) and B)
F) A) and C)

Question 17

A claim control number is assigned by

Accepted Answer

A)   the medical office
B)   Medicaid
C)   health plan
D)   subscriberE) B) and C)
F) B) and D) A

Question 18

What organization provides updates the CMS-1500?

Accepted Answer

A)   HIPAA
B)   OIG
C)   NUCC
D)   CMSE) B) and C)
F) A) and C)

Question 19

The claim frequency code for physician practice claims indicates all of the following except:

Accepted Answer

A)   an original claim
B)   a replacement of a prior claim
C)   going to be rejected or not
D)   a voided or canceled prior claimE) B) and C)
F) None of the above C

Question 20

In the direct transmission approach, providers and payers exchange transactions directly without using what?

Accepted Answer

A)   clearinghouse
B)   paper form
C)   HCFA-1500
D)   HIPAA claimE) B) and D)
F) None of the above

Exam 7: Health Care Claim Preparation and Transmission

What is the most common method to handle health care claim transmission?

Correct AnswerverifiedShow Answer

The part of the HIPAA claim contains information about the payer to whom the claim is going to be sent, called the

Correct AnswerverifiedShow Answer

What does a place of service (POS) code describe about a service provided?

Correct AnswerverifiedShow Answer

Which is not a major method of transmitting claims electronically?

Correct AnswerverifiedShow Answer

What code is used to indicate whether a claim is an original, replacement, or voided code?

Correct AnswerverifiedD

In the direct claims transmission approach, which formatting rules should the provider follow?

Correct AnswerverifiedShow Answer

The NUCC can be expected to continue to update what form?

Correct AnswerverifiedShow Answer

A unique number assigned by the sender to each service line is a

Correct AnswerverifiedShow Answer

With a few exceptions, the electronic claim is the same as __________.

Correct AnswerverifiedShow Answer

The letters "SOF" on a claim mean

Correct AnswerverifiedShow Answer

The carrier block on the CMS 1500 form is for

Correct AnswerverifiedShow Answer

The term service line information describes section 24 of the CMS-1500 claim, which reports

Correct AnswerverifiedShow Answer

The claim frequency code is sometimes known as the

Correct AnswerverifiedShow Answer

Which types of claims are generally used for reporting physicians' services?

Correct AnswerverifiedShow Answer

If a paper RA is received, what should be sent to the secondary health plan?

Correct AnswerverifiedShow Answer

The organization or person transmitting the claim to the payer is the

Correct AnswerverifiedShow Answer

A claim control number is assigned by

Correct AnswerverifiedA

What organization provides updates the CMS-1500?

Correct AnswerverifiedShow Answer

The claim frequency code for physician practice claims indicates all of the following except:

Correct AnswerverifiedC

In the direct transmission approach, providers and payers exchange transactions directly without using what?

Correct AnswerverifiedShow Answer

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A

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