Question

select all that apply

which of the following information is included under an electronic benefit inquiry?

the period of dates the health plan coverage is active
the benefit units and how many visits are covered
the referral number and services covered under the referral.
the coverage level and who is covered under the policy

Explanation:

Understand the concept of an electronic benefit inquiry

An electronic benefit inquiry (often conducted via HIPAA 270/271 transactions) is used by healthcare providers to verify a patient's insurance eligibility and specific coverage details before services are rendered. This process falls under Eligibility Verification Steps.

Analyze each option based on standard eligibility verification

• The period of dates the health plan coverage is active: This is a core component of eligibility verification. The inquiry returns the active start and end dates of the policy to ensure the patient is currently covered.
• The benefit units and how many visits are covered: An inquiry retrieves specific benefit limitations, such as the number of physical therapy visits or chiropractic visits allowed per calendar year.
• The referral number and services covered under the referral: Referral numbers are generated after a referral request is submitted and authorized. They are not a standard part of a general benefit/eligibility inquiry, which checks overall plan rules rather than active, specific prior authorizations or referral decisions.
• The coverage level and who is covered under the policy: The inquiry confirms the level of coverage (e.g., individual vs. family) and verifies the demographic details of who is covered under the policy (subscriber vs. dependents).

Determine the correct selections

Based on standard medical billing and administrative procedures, the information returned in an electronic benefit inquiry includes:

1. The active coverage dates.
2. The benefit units/visit limits.
3. The coverage level and covered individuals.

Answer:

• The period of dates the health plan coverage is active (Correct answer)
• The benefit units and how many visits are covered (Correct answer)
• The referral number and services covered under the referral.
• The coverage level and who is covered under the policy (Correct answer)