CHAA CHAA Denial Management and Claims Processing 1

Question 1

What is a claim denial in the context of healthcare revenue cycle?

Accepted Answer

When a payer refuses to reimburse a submitted claim fully or partially

Answer

A claim denial occurs when a payer determines that all or part of a submitted claim does not meet requirements for reimbursement, requiring follow-up or appeal.

Question 2

Which type of denial can be corrected and resubmitted by the provider?

Accepted Answer

Soft denial (or correctable denial)

Answer

A soft denial is one where the payer will reconsider and pay the claim if additional information, a correction, or documentation is submitted.

Question 3

What is a 'hard denial' in claims management?

Accepted Answer

A denial that is final and cannot be overturned without a formal appeal

Answer

A hard denial represents a final refusal to pay that requires a formal appeal process if the provider believes the denial is incorrect.

Question 4

Which denial root cause originates in the patient access department due to missing or incorrect information at registration?

Accepted Answer

Front-end denial

Answer

Front-end denials are caused by errors or omissions in registration data such as incorrect demographics, missing insurance information, or absent authorizations.

Question 5

What does 'timely filing' mean in the context of claim submission?

Accepted Answer

Submitting claims to the payer within the contractually specified deadline after service

Answer

Timely filing limits require claims to be submitted within a specified window (e.g., 90 or 180 days) after the date of service; claims submitted late are typically denied.

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA CHAA Denial Management and Claims Processing 1