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The Rules of the Game: Contracting, Credentialing and Negotiating with Managed Care in Audiology

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1.  Before an audiologist can complete a third-party enrollment process, the audiologist must have: State audiology license National Provider Identifier Tax identification number of business All of the above

2.  CAQH is a: Credentialing clearinghouse Federal government agency Third-party insurer State agency

3.  The best way to begin the enrollment process is to: Mail an inquiry to the insurer Call the insurer Google search Personally meet with the insurer

4.  Things to consider when evaluating managed care contracts include: Terminology on medical necessity Renewal terms Termination terms All of the above

5.  When reviewing determining which payers to consider contracting with, an audiologist should consider: What insurers represent the major employers in the area What insurers do referral sources contract with What insurers do local hospitals contract with All of the above

6.  A closed network is one where: An insurance network that is open to new providers An insurance network that is closed to new providers An insurance network that has a fixed fee schedule An insurance network that utilizes CAQH

7.  When a contract "evergreens" it: Automatically renews Automatically terminates Requires re-enrollment and credentialing Adjusts according to Medicare rate changes

8.  To participate with CAQH, a provider must be: A physician A Medicare provider A contracted provider with a least one of the CAQH participating payers A new provider

9.  Before a provider signs a third-party contract, they should: Make a copy of the entire agreement and fee schedule Consult an attorney if unsure of any of the contract terms Analyze the pros versus cons of the contract for your practice All of the above

10.  When reviewing a third-party contract, providers should be careful of: Large provider discounts Invoice plus arrangements Line item limits All of the above