Capitation rates vary from contract to contract, but most offer extra payment for:
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Q. 2) The MCP is responsible to keep a log of ______________ claims
a. approved
b. denied
c. authorized
d. unauthorized
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Q. 3) It is the responsibility of the MCP to review denied claims logs to ensure that the IPA is:
a. issuing appropriate denials.
b. being consistent with the denials process.
c. notifying the patients in a timely fashion of appeal decisions.
d. All of the above
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Q. 4) If scheduling requires a provider to refer a patient to see another provider, who is responsible to pay the second provider?
a. The first provider
b. The MCP
c. The patient
d. The second provider
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Q. 5) A second opinion may be requested by an MCP member if:
a. the proposed procedure is deemed medically unnecessary.
b. the patient wants a different physician.
c. the patient is not satisfied with the surgery performed.
d. the patient is a no-show for an appointment.
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Q. 6) What should the provider do if correspondence sent to a patient is returned as undeliverable or no longer at this address?
a. Call the patient and get the new address and resend the correspondence.
b. Place the returned correspondence in the envelope with the date received stamped on the envelope.
c. Notify the MCP.
d. All of the above
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Q. 7) If a provider cannot meet the MCP time frames for seeing a patient in the recommended amount of time, the provider should:
a. see the patient as soon as possible.
b. refer the patient to another provider.
c. stay late to see the patient.
d. send the patient to the emergency room.
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Q. 8) To meet the requirements for appointment scheduling, the MCP may require a certain number of appointments to be available for:
a. urgent care.
b. emergency care.
c. routine care.
d. problem-oriented care.
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Q. 9) Most MCPs have time frames established for _____________________ waiting periods for appointments of various kinds of services.
a. minimum
b. maximum
c. mandatory
d. all
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Q. 10) New members will not be on an eligibility roster until:
a. the first month after they sign up.
b. they choose a PCP provider.
c. they need to see a physician.
d. they log in to their insurance account online.
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