Q 1. World Health Organization (WHO) developed codes which were commonly known as?
Q 2. The card issue by the TPA holds its relevance at the time of claim. The card contains details like, except:
Q 3. Indian Insurance Companies have been battling with the high loss ratio in health insurance segment due to?
Q 4. Hritik returned from school with red patches on hands and face. His mother took her to hospital. The doctor categorized the infection as what amongst the following?
Q 5. Codes were developed for both the disease and the procedures to treat the diseases. Such procedural codes were called?
Q 6. Identify the disadvantage of the Cashless Service?
Q 7. A wellness program, just for the sake of it given as a marketing gimmick, without ________________ will ne no real help in cost containment.
Q 8. Which amongst the following is the vital organ from the insurance point of view keeping the fact that most of the chronic ailments and high value claims arise from the disease related to these organs?
Q 9. Why do we need the standardize codes for illness and treatment?
Q 10. For all the services offered by the TPA, it is paid a fee on one of the following basis, that will not include:
a) A percentage of the premium
b) A percentage of the approved claim amount
c) A fixed amount for each member serviced by the TPA for a defined time period
d) A fixed amount for each transaction of the service provided by the TPA
e) A fixed amount based on the number and policy duration of the customer.
Q 11. One of the very important and crucial step for the cost control measure is Strict Claims Management. Identify the ways in which the same can be done?
A) Trend Analysis of claims arising from a particular provider
B) Establish and enforce usual, customary and reasonable charges
C) Close scrutiny of claims, audit and double check
Q 12. Which is the largest organ of the body?
Q 13. Find the word closest in meaning to the word in bold:
The Insurance Information Bureau (IIB) which is a part of IRDA, has started a repository to analyze the information on coding.
Q 14. Sohail was ready for discharge. However his total bill was greater than the approved credit amount in his account by the TPA. What will be the treatment for his bill?
Q 15. Case management is best suitable for groups only because?
Q 16. Common medical conditions that confirms the issues related to the nervous system are?
Q 17. Identify what follows the Coding of Claims Procedure?
Q 18. Ashish had been operated for his treatment under the ABC hospital. The ABC hospital did not fall under the list of the network hospitals of TPA. How will the claim be treated?
Q 19. How does the wellness programs impact the human beings for their wellness?
A) They will empower the insured to adopt a healthy lifestyle
B) Increase in number of healthy clients with increased health risk
C) Better Customer Satisfaction which will foster economic growth.
D) Decrease in the average claims size ratio
Q 20. Identify the metabolic disorder characterized by persistent hyperglycaemia due to disturbances in carbohydrate, fat and protein resulting from disorders in insulin secretion or insulin action?
Q 21. Fill in the blank:
The heart of the claim processing is in the fact whether the claim is __________ under the policy.
Q 22. TPA will process the claim and recommend for payment to the hospital after verifying few details. Identify what is not verified by the TPA from the following?
Q 23. Provider Management includes all except:
Q 24. The human respiratory system is divided into two parts upper and lower respiratory system. The Upper Respiratory Tract includes all except
Q 25. Find the synonym of the word in bold and underlined.
The Non-Inclusion of names of newly wed wife or the new borne child under the policy will not offer coverage to them.
Sign-up with Google