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Question 81

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Premises:
Code shown on an explanation of benefits (EOB) to explain the coverage determination or a denial
A number used to multiply or divide a quantity when converting from one system of units to another
Version of the explanation of benefits (EOB) sent to the provider by the insurance carrier after the processing of electronic claims
The maximum amount an insurance carrier will pay for a covered service
Percentage of the cost of covered services that the policyholder must pay
Percentage of the provider's payment held back to offset any additional costs under a capitation agreement
The amount that a policyholder must pay for covered services before insurance benefits begin to pay
A set amount that the patient must pay at the time of service
The steps involved in the processing and payment or denial of a claim
Unit of measurement assigned to a service based on the skill and time required to perform it
Responses:
deductible
adjudication
electronic remittance advice (ERA)
relative value unit
copayment
conversion factor
allowed charge
withhold
reason code
coinsurance

Correct Answer:

Code shown on an explanation of benefits (EOB) to explain the coverage determination or a denial
A number used to multiply or divide a quantity when converting from one system of units to another
Version of the explanation of benefits (EOB) sent to the provider by the insurance carrier after the processing of electronic claims
The maximum amount an insurance carrier will pay for a covered service
Percentage of the cost of covered services that the policyholder must pay
Percentage of the provider's payment held back to offset any additional costs under a capitation agreement
The amount that a policyholder must pay for covered services before insurance benefits begin to pay
A set amount that the patient must pay at the time of service
The steps involved in the processing and payment or denial of a claim
Unit of measurement assigned to a service based on the skill and time required to perform it
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