Insurance Verification and Processing Flashcards
6 cards from real CMAA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Insurance Verification and Processing flashcards as text
What is the primary purpose of verifying insurance eligibility before an appointment?
Answer: To ensure the practice will receive payment
Eligibility verification confirms active coverage and that planned services will be covered, ensuring proper reimbursement.
What information is typically found on the back of an insurance card?
Answer: Claims address and customer service phone number
The back typically has the claims submission address, customer service number, and provider services phone for verification and claims.
A patient has both Medicare and employer commercial insurance. Which is typically primary?
Answer: Commercial plan is primary if employer has 20+ employees
Under Medicare Secondary Payer rules, the employer plan is primary if the employer has 20+ employees for aged beneficiaries.
What does 'prior authorization' mean in insurance processing?
Answer: Insurance must approve certain services before they are performed
Prior authorization requires insurance company approval before performing certain services, procedures, or prescriptions.
What is a referral in managed care insurance plans?
Answer: An authorization from the PCP for the patient to see a specialist
In managed care, a referral is PCP authorization directing the patient to a specialist within the plan's network.
A patient has a $2,000 deductible and has met $1,500. The visit costs $200. How much applies to the deductible?
Answer: $200
With $500 remaining on the deductible, the full $200 visit applies since it's less than the remaining amount.