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which of the following is not a typical function of the claims department? A. claims capture...

which of the following is not a typical function of the claims department? A. claims capture B. coordination of Benfits (COB) and Other Party Liability (OPL) C. Application of correct provider payment schedules based on date of service and type of plan. D. Determination of member eligibility on the date of service E. Member enrollment F. Provider payment G. Adjudication

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Answer #1

The claims department functions inbthe following way

  • Settling down claims after the policy holder claims it
  • Scrutinize the documents for its genuinity
  • Pays the provider in accordance withbthw date and type of service received by a patient
  • Checks out the eligibility of the policy holder and enrolment is done.
  • Adjudication is the way of a legal professional (judge ) reviews a case and gives verdict. This cannot be done by a claims department.
  • Ans.G.Adjudication
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