CHAA - Certified Healthcare Access Associate Insurance Verification and Eligibility 3

Question 1

When a patient presents with two active insurance plans, which process determines the order in which each plan pays?

Accepted Answer

Coordination of Benefits (COB)

Answer

Coordination of Benefits (COB) is the process used to determine which insurer is primary (pays first) and which is secondary when a patient has more than one active health plan, preventing duplicate payment beyond 100% of the claim.

Question 2

What is the most appropriate action when a healthcare access associate cannot verify a patient's eligibility prior to a scheduled service?

Accepted Answer

Document the verification attempt, notify the patient, and escalate per facility policy

Answer

When real-time verification fails, the associate must document the attempt and follow the facility's escalation protocol. The patient must be informed, and the encounter should not proceed without leadership guidance to avoid unbillable or denied claims.

Question 3

Which of the following best distinguishes insurance eligibility verification from prior authorization?

Accepted Answer

Eligibility verification confirms that coverage is active; prior authorization confirms that a specific service is approved for payment

Answer

Eligibility verification answers 'Is the patient covered?' while prior authorization answers 'Will the payer approve this particular service?' Both are needed, but they are distinct steps in the revenue cycle workflow.

Question 4

In insurance terminology, who is referred to as the 'subscriber'?

Accepted Answer

The policyholder who holds the insurance contract

Answer

The subscriber is the individual — often an employee or union member — who holds the insurance policy. Dependents covered under that policy are not the subscriber, even though they may be the patient receiving care.

Question 5

A patient's insurance card shows a $3,000 deductible with $1,800 already met. What amount remains before the plan begins covering non-preventive services at the co-insurance rate?

Accepted Answer

$1,200

Answer

The remaining deductible is $3,000 − $1,800 = $1,200. The patient must pay this amount out-of-pocket before the insurer begins sharing costs at the co-insurance rate. Confirming met deductible during eligibility verification prevents unexpected patient billing.

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Insurance Verification and Eligibility 3