A Claim That Is Removed from a Payer's Automated Processing

question 67

Multiple Choice

A claim that is removed from a payer's automated processing system for additional review is subject to:

• A) preauthorization.
• B) manual review.
• C) medical-necessity examination.
• D) claims edit.

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Definitions:

Producer Surplus

The difference between what producers are willing to accept for a good or service versus what they actually receive, measuring their benefit.

Total Surplus

The sum of consumer surplus and producer surplus, representing the total benefit to society from the production and consumption of a good or service.

Tax

A financial charge or levy imposed by a government on individuals, corporations, or transactions to fund public expenditures.

Consumer Surplus

The gap between what consumers are prepared and able to spend on a product or service compared to what they end up paying in reality.