CHAA - Certified Healthcare Access Associate Insurance Verification and Eligibility 2

Question 1

When a patient has both a primary and secondary insurance plan, which process determines which insurer pays first?

Accepted Answer

Coordination of Benefits (COB)

Answer

Coordination of Benefits (COB) is the process used when a patient has multiple insurance plans to determine the order in which each plan pays, preventing duplicate reimbursement exceeding 100% of the claim.

Question 2

A patient's insurance card shows an effective date of 08/01/2026 but today is 07/23/2026. What should the access associate do?

Accepted Answer

Inform the patient their coverage has not yet begun and discuss payment options

Answer

Coverage cannot be billed before the effective date. The associate must inform the patient their policy is not yet active and explore alternatives such as self-pay, financial assistance, or rescheduling.

Question 3

Which term describes the fixed dollar amount a patient must pay out-of-pocket for a covered service before insurance begins to pay?

Accepted Answer

Deductible

Answer

A deductible is the set amount the insured must pay each benefit period before the insurance plan starts covering costs. Copayments are fixed per-visit fees, and coinsurance is a percentage share paid after the deductible.

Question 4

During eligibility verification, a healthcare access associate confirms a patient is 'in-network.' What does this mean for the patient?

Accepted Answer

The provider has a contracted rate with the insurer, typically resulting in lower patient cost-sharing

Answer

In-network status means the provider has negotiated contracted rates with the insurer. Patients generally pay less out-of-pocket than they would for out-of-network services, but cost-sharing like copays and deductibles still apply.

Question 5

Which of the following situations would most likely require a pre-authorization before the service is rendered?

Accepted Answer

An elective MRI ordered by a specialist

Answer

Elective diagnostic imaging such as MRIs frequently requires prior authorization from the insurer to confirm medical necessity before the service is performed. Emergency services are generally exempt from pre-authorization requirements.

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Insurance Verification and Eligibility 2