Prior Authorizations In Healthcare: Quiz!
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When it comes to healthcare, many things are sensitive and should not be disclosed to the public. As a caregiver, some prior authorizations in healthcare that someone is expected to get before they undertake a given task. The quiz below is designed to see just how much you understand them. All the best!
Questions and Answers
- 1.
In order to search for a member under a specific client, you must click the checkbox in front of the Limit Search by Client(s).
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
To search for a member under a specific client, it is necessary to click the checkbox in front of the "Limit Search by Client(s)" option. This indicates that the search will be restricted to the selected client(s) only. By doing so, the system will filter the search results and display only the members associated with the chosen client(s). Therefore, the statement "True" accurately describes the process of searching for a member under a specific client.Rate this question:
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- 2.
If you have located the member's name, you can assume that you have found the correct member. No further verification is necessary.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The correct answer is "False". This means that if you have located the member's name, you cannot assume that you have found the correct member. Further verification is necessary to confirm if the located member is indeed the correct one.Rate this question:
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- 3.
It is acceptable to ask for a member ID number on a call.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Asking for a member ID number on a call is acceptable because it helps to verify the identity of the person being spoken to and ensures that sensitive information is only shared with authorized individuals. This practice is commonly used in various industries such as healthcare, insurance, and banking to maintain security and protect customer data.Rate this question:
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- 4.
When a client tracks dependents, they will report each individual dependent eligible to use the plan.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
When a client tracks dependents, it means that they keep a record of every individual dependent who is eligible to use the plan. This implies that the client will report each eligible dependent, indicating that the statement is true.Rate this question:
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- 5.
A client tracks dependents and a child is listed with the last name of Harrison. The child's last name is actually Starkey. The "Update" button in the Customer Care Portal can be used to correct the error.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The given statement is false. The "Update" button in the Customer Care Portal cannot be used to correct the error of a child's last name being listed incorrectly as Harrison instead of Starkey. The "Update" button is likely used for making changes to certain customer information, but it may not have the capability to correct dependents' details.Rate this question:
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- 6.
You are able to search through a maximum of four clients at one time for a member.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement suggests that there is a limitation on the number of clients that can be searched for a member at one time, which is a maximum of four. This implies that the system or platform being referred to allows users to search for information about their clients, but only up to a maximum of four clients simultaneously. Therefore, the correct answer is "True."Rate this question:
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- 7.
After you have verbally provided an authorization number, what pieces of information are provided to a doctor that requests a full breakdown of the authorization?
- 8.
If a doctor is requesting a backdated authorization more than 6 months from the DOS, you would:
Correct Answer
Transfer the call to CCExplanation
If a doctor is requesting a backdated authorization more than 6 months from the DOS (Date of Service), it indicates a potential issue with the claim. Transferring the call to CC (Customer Care) would be the appropriate action as they would have the expertise to handle such situations and assist the doctor in resolving the issue.Rate this question:
- 9.
Name the field in the Customer Care Portal that you use to backdate an authorization.
Correct Answer
As Of fieldExplanation
The As Of field is the field in the Customer Care Portal that is used to backdate an authorization. This field allows the user to select a specific date in the past to apply the authorization, allowing for retroactive actions or adjustments to be made. By selecting a date in the As Of field, the user can ensure that the authorization is effective from that chosen date, even if it is not the current date.Rate this question:
- 10.
Besides talking with a CSR, what are two other methods the doctor can use to obtain authorization?
Correct Answer
IVR
EyefinityExplanation
The doctor can use IVR (Interactive Voice Response) and Eyefinity as two other methods to obtain authorization besides talking with a CSR. IVR allows the doctor to interact with an automated system using voice commands, which can provide authorization information. Eyefinity is a software platform that offers electronic health records and practice management solutions, which may include authorization features. Both IVR and Eyefinity provide alternative options for the doctor to obtain authorization without relying solely on speaking with a CSR.Rate this question:
- 11.
What is the client ID for the live region client named Vision Benefits Active?
Correct Answer
00857001Explanation
The client ID for the live region client named Vision Benefits Active is 00857001.Rate this question:
- 12.
When completing a member search in the Customer Care Portal, if there is only one Active/Active match in the Member Search Results, the member's information will automatically populate into the:
Correct Answer
Member ProfileExplanation
When completing a member search in the Customer Care Portal, if there is only one Active/Active match in the Member Search Results, the member's information will automatically populate into the Member Profile. This means that when there is only one matching member found, their information will be automatically filled in the Member Profile section, making it easier for the user to access and view the member's details without manually entering them.Rate this question:
- 13.
You see an error message "No coverage Elected" under a dependent's name on the Eligibility Tab. What do you do?
Correct Answer
Transfer the call to CCExplanation
When encountering an error message stating "No coverage Elected" under a dependent's name on the Eligibility Tab, the appropriate action is to transfer the call to the CC (Customer Care) department. This department specializes in handling customer inquiries and issues related to coverage and eligibility. By transferring the call to CC, the customer can receive the necessary assistance and guidance to address the error message and resolve any issues with the dependent's coverage.Rate this question:
- 14.
Look up Randolph B Ahlo. Name two things you will need to verify on this member?
Correct Answer
DOS
Current Client/EmployerExplanation
To verify the information on Randolph B Ahlo, you would need to check his DOS (Date of Service) to confirm the period he has been associated with the organization. Additionally, you would also need to verify his current client/employer to ensure that the information provided is accurate and up-to-date.Rate this question:
- 15.
When searching for clients on the Client Tab, which check box should be clicked to hide termed and pended clients?
Correct Answer
Active Clients OnlyExplanation
The correct answer is "Active Clients Only". This option should be clicked to hide termed and pended clients when searching for clients on the Client Tab. By selecting this check box, only active clients will be displayed in the search results, excluding any clients who have been termed or are currently pending.Rate this question:
- 16.
Which of the following is false regarding faxed authorizations?
- A.
A fax can not be sent to a personal residence.
- B.
A faxed authorization can only be resent to the same office that requested it.
- C.
An authorization not originally issued as a fax can be faxed at a later date.
- D.
Faxing can only be sent to the same fax number on file with VSP.
Correct Answer
D. Faxing can only be sent to the same fax number on file with VSP.Explanation
The statement "Faxing can only be sent to the same fax number on file with VSP" is false because faxing can be sent to any fax number, not just the one on file with VSP.Rate this question:
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- 17.
You are able to split a service for an authorization on:
- A.
Authorization Detail
- B.
Available Benefits Summary
- C.
Doctor Search Criteria
- D.
Member Profile
Correct Answer
B. Available Benefits SummaryExplanation
The available benefits summary can be split for authorization because it provides important information about the benefits that a member is eligible for. This information is crucial for determining whether a service should be authorized or not. By splitting the available benefits summary, the authorization process can be streamlined and specific benefits can be targeted for authorization.Rate this question:
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- 18.
After entering the doctor's phone number in the Eligibility Portlet, an office name appears. What else needs to be appear in order to issue an authorization?
- A.
A green checkmark next to the office name
- B.
A list of the doctors contracted in that office
- C.
A Red "X" next to the patient's benefit type
- D.
The doctor's fax number on file with VSP
Correct Answer
A. A green checkmark next to the office nameExplanation
When entering the doctor's phone number in the Eligibility Portlet, if a green checkmark appears next to the office name, it indicates that the office is eligible for authorization. This means that the authorization can be issued for the patient to receive treatment from the doctor at that office.Rate this question:
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- 19.
Which area is used in the Customer Care Portal to issue multiple authorizations at one time?
- A.
Eligibility Tab
- B.
Member History
- C.
Member Profile
- D.
Member Search Tab
Correct Answer
A. Eligibility TabExplanation
The Eligibility Tab is used in the Customer Care Portal to issue multiple authorizations at one time. This tab allows the user to view and manage the eligibility status of members, including adding or removing authorizations. By using this tab, customer care representatives can efficiently issue multiple authorizations for various services to members, saving time and effort.Rate this question:
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- 20.
A doctor requests to delete an authorization they received last week. You would:
- A.
Ask that they call back
- B.
Delete the authorization
- C.
Tell them the system will automatically delete the auth
- D.
Transfer to CC
Correct Answer
B. Delete the authorizationExplanation
The correct answer is to delete the authorization. This is the appropriate action to take when a doctor requests to have an authorization deleted. By deleting the authorization, you are fulfilling the doctor's request and ensuring that the authorization is no longer active in the system.Rate this question:
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- 21.
Perform a client search in the live region. Do the Sacramento Kings offer VSP?
- A.
Yes
- B.
No
Correct Answer
B. NoExplanation
The given answer "No" suggests that the Sacramento Kings do not offer VSP. This implies that if a client were to search for VSP in the live region, they would not find any information or confirmation that the Sacramento Kings offer this service.Rate this question:
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- 22.
Perform a client search in the live region. Do the Oakland A's offer VSP?
- A.
Yes
- B.
No
Correct Answer
A. YesExplanation
The given answer "Yes" suggests that the Oakland A's do offer VSP (Voluntary Separation Program). This implies that the organization provides its clients with the option to voluntarily separate from the company.Rate this question:
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- 23.
Perform a client search in the live region. Does Christian Dior offer VSP?
- A.
Yes
- B.
No
Correct Answer
A. YesExplanation
The given answer "Yes" suggests that Christian Dior does offer VSP. This means that when performing a client search in the live region, it is possible to find information or products related to VSP from Christian Dior.Rate this question:
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- 24.
Perform a client search in the live region. Does Tiffany & Co. offer VSP?
- A.
Yes
- B.
No
Correct Answer
A. YesExplanation
The given answer "Yes" suggests that Tiffany & Co. does offer VSP.Rate this question:
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- 25.
Perform a client search in the live region. Does Pixar Studios offer VSP?
- A.
Yes
- B.
No
Correct Answer
B. NoExplanation
The given answer "No" suggests that Pixar Studios does not offer VSP (Vision Service Plan). This implies that the company does not provide vision insurance or related services to its clients.Rate this question:
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- 26.
Perform a client search in the live region. Does Dreamworks Animation offer VSP?
- A.
Yes
- B.
No
Correct Answer
A. YesExplanation
Dreamworks Animation offers VSP (Vision Service Plan) as indicated by the answer "Yes". This suggests that clients can perform a search in the live region to find information about VSP offered by Dreamworks Animation.Rate this question:
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- 27.
Name four of the most common search criteria combinations used in the Member Search Tab.
- 28.
Describe how to delete an authorization in the Eligibility Tab.
Quiz Review Timeline +
Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.
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Current Version
-
Mar 19, 2023Quiz Edited by
ProProfs Editorial Team -
Jul 18, 2011Quiz Created by
Quizard
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