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:

Urban Areas

Densely populated regions characterized by higher rates of industrialization, infrastructure, and cultural activities when compared to rural areas.

Biculturalism

The belief that it is possible to live and function effectively in two cultures.

Tribe Affiliation

The association or connection with a specific tribe, often denoting shared ancestry, culture, or traditions.

Noninterference

A principle or policy of not becoming involved in the affairs of others or not intervening in natural processes.