Infosys Certified- Healthcare Claims Processing
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Join Premium10 Infosys Certified- Healthcare Claims Processing practice questions with answers
Real Lex exam-pattern multiple-choice questions for the Infosys Certified- Healthcare Claims Processing certification. Each question includes the correct answer. The full question bank is available to Premium members.
- Question 1
Potential overpayment can be tracked manually or by a systematic tracking. State True or False.
- ✓ True Correct
- B False
- Question 2
In consolidation process for creation of provider EOB, which of the following parameters are considered for grouping?
I. Subscriber Id & Provider ID
II. Subscriber Name & Provider Name
III. Subscriber Address & Provider Address
IV. Provider Billing- ✓ IV Correct
- B I, II, III and IV
- C I, II and III
- D None of the above
- Question 3
Which of the below is considered as part of cost sharing?
I. Copayment
II. Deductible and Coinsurance
III. Copayment and Deductible
IV. Coinsurance- ✓ I and IV Correct
- B II
- C I and II
- D III
- Question 4
Choose the correct option below.
- ✓ Plan-sponsor funding to insurance company is linked with overpayment processing and recovery. Correct
- B Plan-sponsor always funds insurance company without any link to overpayment processing and recovery.
- C Plan-sponsor concept is not applicable for healthcare claims.
- D Plan-sponsor is only associated with underpayment.
- Question 5
The claim adjustment request can be made using
- ✓ standard UB92 forms Correct
- B CMS 1500 forms
- C the insurer specific request form
- D All of the above
- Question 6
During medical billing process, electronic claims are usually formatted using HIPAA-837 standard transaction set. State True of False.
- ✓ True Correct
- B False
- Question 7
As per ICD10 format, first 3 bytes of diagnosis code indicates category of disease. State True or False.
- ✓ True Correct
- B False
- Question 8
Which HIPAA standard transaction is used by the providers to request an authorization from the payer?
- ✓ EDI Health Care Service Review Information (278) Correct
- B EDI Health Care Claim Status Notification (277)
- C EDI Health Care Claim Status Request (276)
- D EDI Health Care Eligibility/Benefit Response (271)
- Question 9
Which of the following is true with respect to Coordination of Benefits (COB).
I. Under COB, both the primary and secondary payer pays all the benefits that are covered by the policy.
II. Coordination of benefits is designed to prevent duplication of benefits when a person is covered by two or more policies.
III. COB prevents overpayment/multiple payments of a claim by more than one carrier.
IV. Under COB, both primary and secondary carrier pays the claim at the same time.- ✓ I and III Correct
- B I, II, III
- C II and III
- D I, II, III, IV
- Question 10
Select the correct option below which best describes the concept of validation of an overpayment.
I. Validation of an overpayment is necessary to ensure the correctness of the overpayment.
II. Validation can happen once the overpayment recovery is done.
III. Claim, member and provider data is necessary for investigating the validation of the overpayment.
IV. Validation of overpayment is not at all required.- ✓ I and IV Correct
- B I, II, III
- C II and IV
- D I and III
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