A claims examiner follows a systematic process in which he identifies all pertinent claim issues in order to maintain consistency and accuracy. Which of the following is NOT considered to be an issue that would be examined by this individual?
a. Issues with eligibility at the time of the claim
b. Indications of other possible coverage plans
c. A determination of what the policy/plan language provides
d. Issues of keeping the claimant informed
Question 2
Which of the following claims are NOT normally referred to more technical personnel?
a. Lawsuits, legal actions, or legislative issues
b. Flagged providers
c. Fraud
d. Major medical benefits
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