Team 1
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Team 2
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Teams
Name
Score
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heart
Other team wins 20 points!
Oops!
×
shark
Other team loses 15 points!
Okay!
×
rocket
Go to first place!
Okay!
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lifesaver
Give 15 points!
Oops!
10
×
What would the Resolution Action be for a member calling in about a denial letter?
Appeal Rights Provided
Oops!
Check
Okay!
Check
20
×
When is Denial Code D8 used?
When prior approval not granted because the criteria was not met and the service is being billed without approval.
Oops!
Check
Okay!
Check
15
×
What is the timely filing for Medicare Advantage Par Providers?
180 Days (6 months) from Date of Service
Oops!
Check
Okay!
Check
×
monster
Reset all scores!
Oops!
×
gold
Win 50 points!
Okay!
×
gift
Win 25 points!
Okay!
×
baam
Lose 15 points!
Oops!
15
×
What two pieces of information should always be in documentation regarding a claim?
Claim # & DOS
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Check
Okay!
Check
25
×
If a member wants to request a claim form to file claim, what are the steps for s2w?
Submit to Workflow > MAPD/PDP > Claims > Member- Filed Claim
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Check
Okay!
Check
20
×
How long does a provider have to file a corrected claim?
12 Months from Date of Service
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Check
Okay!
Check
5
×
What is the Denial Reason for code D8?
DENY:PAR PROV DO NOT BILL MBR-SVC NOT PRIOR APPROVED & NOT URG/EMERGENT
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Check
Okay!
Check
5
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How long do members have for timely filing?
12 months from the Date of Service
Oops!
Check
Okay!
Check
×
thief
Give points!
5
10
15
20
25
×
seesaw
Swap points!
Okay!
×
shark
Other team loses 15 points!
Okay!
×
banana
Go to last place!
Oops!
×
eraser
Reset score!
Oops!
×
rocket
Go to first place!
Okay!
×
fairy
Take points!
5
10
15
20
25
×
thief
Give points!
5
10
15
20
25
20
×
If a check was not sent to a correct affiliation, what are the steps to S2W?
Submit to Workflow > MAPD/PDP > Claim > Claim Ops
Oops!
Check
Okay!
Check
25
×
What type of appeal rights do members have with D8 Denial?
Post Service Provider Appeal
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Check
Okay!
Check
25
×
If a provider called to have a check reissued for a claim they didn't receive, what must be documented?
The providers financial address
Oops!
Check
Okay!
Check
5
×
What is the timely filing for Part D claims filed by Provider?
3 Years from Fill Date
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Check
Okay!
Check
×
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