Health Insurance Claim Processing and Adjudication Quiz
Test your knowledge on health insurance claim processing with questions on pre-authorization, EOB, denial reasons, COB, clean claims, and more.
#1
What is a pre-authorization in health insurance claim processing?
A process where the insurer confirms coverage before a medical service is provided
A process where the insurer reimburses the policyholder after medical service is provided
A process where the insurer denies coverage for a medical service
A process where the insurer reviews the claim after payment is made
#2
What does EOB stand for in health insurance?
Explanation of Benefits
Estimated Out-of-Pocket Costs
Emergency Outpatient Billing
Endorsement of Obligated Bills
#3
What does COBRA stand for in health insurance?
Consolidated Omnibus Budget Reconciliation Act
Continuation of Benefits and Reimbursement Agreement
Coordination of Benefits and Risk Assessment
Consolidated Outpatient Billing and Reimbursement Act
#4
What is the purpose of a Explanation of Benefits (EOB) statement?
To provide detailed information on medical treatments
To explain the benefits covered under a health insurance plan
To list the premiums due for the insured
To describe the limitations of coverage
#5
Which of the following is NOT a common reason for denying a health insurance claim?
Non-coverage of the provided service
Lack of medical necessity
Incorrect patient address
Coding errors
#6
What is coordination of benefits (COB) in health insurance?
A process where multiple insurers work together to determine coverage
A process where the insurer coordinates with healthcare providers for payment
A process where the insurer reviews claims for possible fraud
A process where the insurer negotiates rates with healthcare providers
#7
What is medical underwriting in health insurance?
The process of assessing an individual's health status for insurance coverage
The process of filing a claim for medical expenses
The process of negotiating rates with healthcare providers
The process of reviewing claims for possible fraud
#8
What is a deductible in health insurance?
The amount the insured must pay out-of-pocket before the insurance company pays
The fixed monthly payment made by the insured to the insurance company
The maximum amount the insurer will pay for covered services in a policy period
The percentage of covered expenses paid by the insured after the deductible is met
#9
What is meant by 'clean claim' in health insurance?
A claim submitted with all required information and without errors
A claim submitted by a policyholder without pre-authorization
A claim that has been denied by the insurer
A claim for services not covered by the insurance policy
#10
What is a 'lifetime maximum' in health insurance?
The maximum amount of time a person can hold an insurance policy
The maximum amount the insurer will pay over the insured's lifetime
The maximum amount of coverage for a specific medical condition
The maximum number of claims that can be filed in a lifetime
#11
What is 'subrogation' in health insurance?
A process where the insured transfers their policy to another person
A process where the insurer recovers costs from a third party
A process where the insurer pays for medical expenses upfront
A process where the insured receives reimbursement for medical expenses
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