CHAA Insurance Verification and Eligibility

Question 1

What is the primary purpose of insurance eligibility verification?

Accepted Answer

To confirm that a patient has active insurance coverage and to understand their benefits before services are rendered

Answer

To determine the patient's medical diagnosis

Answer

To collect the patient's copayment

Answer

To schedule follow-up appointments

Question 2

Which of the following is NOT typically verified during insurance eligibility checks?

Accepted Answer

Patient's blood type

Answer

Active coverage status

Answer

Deductible and copay amounts

Answer

In-network provider status

Question 3

What is a '270' transaction in the context of eligibility verification?

Accepted Answer

An electronic health care eligibility inquiry sent to a payer

Answer

A patient billing statement

Answer

A claim submission form

Answer

A referral authorization request

Question 4

What information is returned in a '271' eligibility response?

Accepted Answer

Coverage status, plan details, deductible information, copay amounts, and benefit specifics

Answer

The patient's complete medical history

Answer

The provider's tax identification number

Answer

The patient's prescription history

Question 5

When should insurance eligibility verification ideally occur?

Accepted Answer

At least 48-72 hours before the scheduled appointment and again at the time of service

Answer

After the patient has been discharged

Answer

Only when the patient requests it

Answer

After the claim has been submitted

Question 6

What is the difference between 'eligibility' and 'benefits verification'?

Accepted Answer

Eligibility confirms active coverage, while benefits verification determines specific plan details like deductibles, copays, and covered services

Answer

They are exactly the same thing

Answer

Eligibility is done by the payer, benefits by the provider

Answer

Benefits verification is only needed for surgical patients