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Good Cause Assessment

A visually appealing graphic representing healthcare claims processing and assessment, featuring elements like medical documents, clock symbols for timelines, and question mark icons.

Good Cause Assessment Quiz

Test your knowledge and understanding of Good Cause criteria and claims processing with our engaging quiz. Whether you're a professional in the field or just looking to learn more, this quiz offers valuable insights.

10 carefully crafted multiple-choice and checkbox questions.
Assess your understanding of timelines, definitions, and exceptions.

10 Questions2 MinutesCreated by AssessingAudit452

What is the date of denial?

EOB/PRA date describing the reasons for a denied claim

The date UHG receives and Appeal or Grievance.

The date you begin working an appeal in ATS

What is the document that provides direction on determining timely filing?

M&R Compliance Grid

Part C Post Service SOP

Good Cause & Late Filing SOP

Scenario Research Tool

Which of the following are valid good cause rationales

Death in the family

Too busy to get paperwork done

Billy went to see his doctor on May 2, 2022 but his claim denied on May 28, 2022. We received an appeal from Billy on September 9, 2022. Was the appeal received timely?

Yes

Which of the following definitions describe Balance Billing?

The member receives a bill from the provider for the charges not paid by the plan

The provider bills the member for their cost share.

The member gets a second notice regarding an unpaid copay.

The member feels they should have no out of pocket costs due to being dual eligible.

You're dismissing a Non Par Provider appeal for lack of Good Cause. Which document is not required to be included on the case?

INIT CORR

PRA

ELIG SCREEN

PROV ELIG STATUS

POE

CLAIM

What are considered to be Good Cause Exceptions?

Balance Billing, Clerical Errors, Fraud Waste Abuse Errors

Balance Billing, Duplicate Claims, Fraud Waste Abuse & Errors

What are the possible outcomes for a Good Cause review?

Dismiss or Accept

Accept or Void

Withdraw, Void, Accept, Dismiss

Non Par Provider submitted an untimely appeal. Review the UID PTPAP-20220822094929455 and determine if there is GC for filing outside the 180 days allowed.

Yes

Reference the Good Cause for Late Filing SOP. If a correspondence contains a WOL and is received after a case has dismissed for lack of WOL and Good Cause, what does the SOP direct you to do?

Dismiss for lack of GC

Accept for timely filing

Reclassify case to an Inquiry

Send your case for void

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