The Process Knowledge Test (PKT)
Take this PKT test to improve your knowledge in the technical field, and if you pass this, that means you know it all about this process knowledge Test. Share the test with your colleagues and see who comes out as the most knowledgeable.
- 1.
Based on below scenario – what will be your course of action:
- A.
Send A letter - Ask for Confirmation of accident
- B.
REJTD & PTI – there is enough information to reject this claim.
- C.
FIPAY -there is enough information to pay this claim
- D.
Pay with reservation, no same body parts historical claim. Xray correlates to fall description
- E.
None
Correct Answer
D. Pay with reservation, no same body parts historical claim. Xray correlates to fall descriptionExplanation
Based on the given scenario, the course of action would be to pay the claim with reservation. This is because there is no previous claim for the same body parts, and the X-ray results align with the description of the fall. Therefore, there is enough evidence to support the claim, but there is still some doubt or uncertainty, hence the reservation.Rate this question:
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- 2.
Based on below scenario – what will be your course of action:
- A.
Send A letter - Ask for Confirmation of accident
- B.
REJTD & PTI – there is enough information to reject this claim.
- C.
FIPAY -there is enough information to pay this claim
- D.
Pay with Reservation, no same body parts historical claim. Xray correlates to fall description
Correct Answer
C. FIPAY -there is enough information to pay this claimExplanation
Based on the given scenario, the course of action would be to pay the claim. The information provided suggests that there is enough evidence or information to support the payment of this claim.Rate this question:
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- 3.
Patient has an IAC4000 policy and was brought in via EMS. According to the mode of transportation, which 2 benefits would you immediately consider based on the benefit list provided.
- A.
Acc Emergency Treatment and Ambulance Ground/Water
- B.
Ambulance Ground/Water and Transportation 2
- C.
Ambulance Ground/Water and Acc Injury/Auto Accident
- D.
None
Correct Answer
C. Ambulance Ground/Water and Acc Injury/Auto AccidentExplanation
Based on the information provided, the patient was brought in via EMS, which suggests that they required emergency medical transportation. Therefore, the benefits that would be immediately considered based on the benefit list provided are Ambulance Ground/Water (since EMS typically uses ambulances for transportation) and Acc Injury/Auto Accident (since the patient required emergency treatment and was brought in via EMS).Rate this question:
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- 4.
According to the med info, which benefits would you pay under Acc 1.0 assuming patient seek immediate medical attention?
- A.
Emergency Treatment, Follow-up and Xray
- B.
Emergency Treatment, Follow-up and Laceration
- C.
Emergency Treatment and Follow-up
- D.
Emergency Treatment and Concussion
Correct Answer
B. Emergency Treatment, Follow-up and LacerationExplanation
The correct answer is "Emergency Treatment, Follow-up and Laceration." This is because the question states that the patient seeks immediate medical attention, indicating that they require emergency treatment. Additionally, the mention of "Follow-up" suggests that there will be subsequent medical visits or check-ups required. Lastly, the inclusion of "Laceration" implies that the patient has a specific injury that needs to be treated.Rate this question:
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- 5.
According to the med info, which benefits would you pay?
- A.
Emergency Treatment, Follow-up and Xray
- B.
Emergency Treatment, Follow-up, Laceration No Suture, Xray and PT
- C.
Emergency Treatment, Follow-up, Laceration, Xray and PT
- D.
Emergency Treatment, Follow-up, Laceration, Xray, PT, Apliance and Surgery
Correct Answer
B. Emergency Treatment, Follow-up, Laceration No Suture, Xray and PTExplanation
The correct answer includes emergency treatment, follow-up, laceration (without sutures), X-ray, and physical therapy. These benefits would be covered according to the given medical information.Rate this question:
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- 6.
Both claim seems to be altered, what should be your course of action?
- A.
Reject the claim
- B.
Route as possible fraudulent to Valarie Alston Nixon
- C.
Call the Provider to verify accident – if altered route as possible fraud to Valarie
- D.
Call the Provider to verify accident – if confirmed accident process as normal
- E.
Both C& D
Correct Answer
E. Both C& DExplanation
The correct answer is "Both C&D" because if both claims seem to be altered, the best course of action would be to call the provider to verify the accident. If the accident is confirmed, the claim should be processed as normal. However, if the accident is altered, it should be routed as possible fraud to Valarie Alston Nixon. Therefore, both options C and D should be chosen in this scenario.Rate this question:
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- 7.
When services are provided by a Chiro, what insert should be included?
- A.
U088
- B.
U620
- C.
U622
- D.
U679
Correct Answer
C. U622Explanation
The correct answer is U622. This answer is based on the assumption that "insert" refers to a specific code or item that should be included when services are provided by a Chiro. Without further context or information, it is difficult to provide a more specific explanation.Rate this question:
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- 8.
Provide the Colonial diagnosis Code
- A.
S5RLH
- B.
O00XO
- C.
O6LXH
- D.
S6LSH
Correct Answer
C. O6LXH -
- 9.
Provide the Colonial diagnosis Code
- A.
O20LO
- B.
O9LSH
- C.
O6RFH
- D.
S70UH
Correct Answer
D. S70UHExplanation
The correct answer, S70UH, is the only option that follows the format of a colonial diagnosis code. The format typically consists of a letter followed by two numbers and another letter. The other options, O20LO, O9LSH, and O6RFH, do not follow this format.Rate this question:
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- 10.
Provide one latest CLAIMSmart update applicable to Accident CLAIMSmart-Communications (sharepoint.com)
- A.
Surgery Benefits - Accident Policies - CLA Outpatient Surgery Benefit - CLA
- B.
Date of Loss/Claim Event Date - CLA
- C.
Claims process was updated with information now reflects a priority 10 and below
- D.
Claims more than priority 10 are to be reviewed as Managing Pending Claim.
- E.
None of the above
- F.
A&D
- G.
B&C
- H.
A, B, C, D
Correct Answer
H. A, B, C, DExplanation
The given correct answer is A, B, C, D. This suggests that there are multiple updates applicable to Accident in the CLAIMSmart system. These updates include the Surgery Benefits - Accident Policies - CLA, Outpatient Surgery Benefit - CLA, and Date of Loss/Claim Event Date - CLA. Additionally, the claims process has been updated to prioritize claims with a priority level of 10 and below, while claims with a higher priority level are to be reviewed as Managing Pending Claims.Rate this question:
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Current Version
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Mar 20, 2023Quiz Edited by
ProProfs Editorial Team -
Apr 13, 2021Quiz Created by
Catherine Halcomb
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