What does MAC stand for? , MAXIMUM ALLOWABLE COST , MARKET ALLOWED COST , MAXIMUM ACCUMLATOR COST , MINIMUM ALLOWED COST , 1. WHAT PRICE SCHEDULE SHOULD BE ATTACHED TO AN HMO EXCHANGE (RETAL) PLAN THAT HAS MANDATORY MAIL? , BZCMMH R, BZXMMH R, BZXSTMMLH R, BZXBRCVH R, WHAT PA CARRIER LIST WOULD YOU USE FOR A RELIGIOUS AFFILIATION GROUP? , BZPAAFF, BZPAREL, BZPAALLEXC, BZPAALRLGN, TRUE OR FALSE: NO RX PLANS HAVE EDIT 31 TURNED OFF. , TRUE , FALSE, EDIT 6 SHOULD BE CODED WITH ________ FOR ALL LINES OF BUSINESS, B, L, Y, Z, What job aid can you find coding steps for plans with Mandatory Mail?, BCBS Job Aid- Variable Copay, BCBS Job Aid-Maintenance, BCBS Job Aid-Mail Saver Programs WIP, BCBS Job Aid-Patient Pay, On claim number 231073923685028 the patient pay states 100%COPAY. What does this mean? , Member will pay $0 dollar, Member will pay 100 percent of the copay, Member is responsible for the full cost of the drug, Members deductible was met , In edit 4 these list names (BZMSPOP AND BZMSPOPG) are associated with this type of specialty pharmacy network? , Open , Exclusive Specialty , Compounds are made up of at least how many ingredients ?, 1 , less then 2 , 2, For HMO Commercial and Exchange plans, what should the Effective Date at Edit 32 be, 011001, 061023, 060123, 010101, BONUS: During adjudication, in what order does the "snake" go to read the edits ?, Plan Edits 1 – 9, then skips to Plan Edit 31, then back to Plan Edits 10 – 30 and then Plan Edit 32, Plan Edits 1 – 3, then skips to Plan Edit 31, then back to Plan Edits 4 – 30 a, Plan Edits 1 – 8, then skips to Plan Edit 31, then back to Plan Edits 9 – 30 and then Plan Edit 32.

TMI-GENERAL KNOWLEDGE

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