Claims Quiz

Question 1

The submitted fee is accepted from all non-participating providers

Accepted Answer

True

Question 2

The member's Claim Payer ID Number....

Accepted Answer

Is for Providers to submit claims electronically

Question 3

The amount a Primary Insurance paid may be written on the claim form in the Remarks section?

Accepted Answer

False

Question 4

What resource will help you research a providers participating status on a claim's Date of Service?

Accepted Answer

National Provider File

Question 5

Assignment of Benefits refers to...

Accepted Answer

Claim Check Payments

Question 6

How long does a member/provider have to submit a claim??

Accepted Answer

12 months from Date of Service

Question 7

What resource will help you research codes that conflict with other codes?

Accepted Answer

EPP

Question 8

If a Member with a PPO policy goes to an Out of Network Dentist they will pay.....

Accepted Answer

Pay PPO Co- Insurance + difference in OON Submitted and PPO MCA

Question 9

Where can you locate the Enterprise Procedural Processing Job Aid

Accepted Answer

ORL/CTR, Sharepoint

Question 10

What system allows you to review if the Primary EOB was sent in with the claim

Accepted Answer

Macess

Question 11

Assignment of benefits only apply to OON providers?

Accepted Answer

True

Question 12

DCN Stands for...

Accepted Answer

Document Control Number

Question 13

Delta Dental will accept claims from providers out of the country

Accepted Answer

True

Question 14

Delta Dental Only accepts ADA Claim forms?

Accepted Answer

False

Question 15

If the members plan accepts Assignment of Benefits then the claim check....

Accepted Answer

May go to the member

Question 16

Members may call in to give OIC information over the phone so that MOSA can be updated

Accepted Answer

True

Question 17

The Billing Provider's and Treating Provider's information are always the same?

Accepted Answer

False

Questions 17