QUESTIONS AND ANSWERS 100

Quantum Health Assessment EXAM

QUESTIONS AND ANSWERS 100%

SOLVED (Newest 2025)

Short Answer Questions: List 3 pieces of information needed

to verify a members identification in order to discuss PHI - Correct Answers ✅1. ID Number

• Name
• Date of Birth

Short Answer Questions: What are 3 places/ways to find an

EOB. - Correct Answers ✅1. TPA Website

• Members website
• Internal Claim

Short Answer Questions: Define deductible. - Correct

Answers ✅The fixed dollar amount that is the responsibility of the member/family to pay before the plan starts to pay a certain percentage.

Short Answer Questions: Define Out of Pocket Maximum -

Correct Answers ✅A fixed dollar amount that is the responsibility of the member/family to pay before the plan will start paying 100% of covered INN services.

Short Answer Questions: What are the 3 pieces of billing

information needed to verify a provider is INN - Correct Answers ✅1. Billing Address

• Billing Name 1 / 2

Quantum Health Assessment EXAM

QUESTIONS AND ANSWERS 100%

SOLVED (Newest 2025)

• Billing Tax ID

Short Answer Questions: When quoting benefits for OP

surgery. Who are the 2 providers we should be checking network status on? - Correct Answers ✅1. Facility

• Surgeon

Short Answer Questions: When a caller is asking about a

claim. What are the 3 pieces of information needed to most efficiently locate that claim? - Correct Answers ✅1. Date of Service

• Total Charged Amount
• Provider Name

Short Answer Questions: When building a pre-cert for an OP

MRI. What are the 4 key items needed? (DO NOT INCLUDE DATE OF SERVICE) - Correct Answers ✅1. CPT Code

• Diagnosis Code
• Ordering Provider
• Facility

Name of the document that outlines every detail of the plan.Also known as the "constitution of the plan." - Correct Answers ✅SPD (Summary Plan Description)

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