Health Plans Often Program into Their Claims Processing Systems Certain

question 141

Multiple Choice

Health plans often program into their claims processing systems certain criteria that, if unmet, will prompt further investigation of a claim. In an automated claims processing system, these criteria may signal the need for further review when, for example:

• A) Encounter reports
• B) Diagnostic codes
• C) Durational ratings
• D) Edits

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Definitions:

Cash

Liquid currency and assets readily convertible into cash, used to fund day-to-day operations and transactions.

Liquidity

A measure of how easily assets can be converted into cash without losing value.

Obligations

Responsibilities or duties bound by law or contract that one party owes another, including the repayment of debts or fulfilling contractual agreements.

Company

An organization engaged in commercial, industrial, or professional activities, which can be a legal entity separate from its owners.