Guarantor Accounts and CRMs
This is created every single time an account is authenticated
What is a CRM?
This is another name for "the insurance team" or "insurance billing specialist."
This action is taken by insurance carriers after reviewing a claim and deciding not to pay it.
What is a denial?
This is a fixed amount to be paid to the doctor's office before the service is provided.
What is a copay?
What is a claim?
This is a summary received from the insurance company, sent to both NYU and the patient (THIS IS NOT A BILL)
What is an EOB?
This is when a patient needs to call their insurance carrier to confirm the order of their coverages.
What is COB? (Coordination of Benefits)
This action takes place when you see a claim was put on temporary hold pending an appeal.
What is defer?
A patient must pay this amount before insurance starts paying, and it resets annually.
What is a deductible?
This is the process of onboarding providers with insurance companies.
What is credentialing?
This tab is accessed to review detailed information about visits, invoices, and transactions.
What is the Professional Tx Inquiry?
When adjusting the filing order, this action also needs to be completed for previous dates of service that were impacted.
What is a VFO update? (Visit Filing Order)
This action is taken when a claim requires a revision to codes, service dates, and/or patient information.
What is a corrected claim?
This entity processes and pays medical claims.
What is a payer?
This type of insurance plan requires referrals from a PCP to see a specialist.
What is an HMO?
This must be created when sending out a request to a different department for research, follow-up, or assistance.
What is a task?
This is marked on a HCFA-1500 claim form in order for NYU to receive payment from the insurance carrier.
What is AOB? (Assignment of Benefits, Box 27)
This action is taken by CS when an insurance carrier calls and asks for the claim to be put on hold as they need more time to reprocess it.
What is task to AR?
This balance type is the patient's responsibility when the insurance denies or if the patient is uninsured.
What is self-pay?
This must be obtained from the insurance carrier before the patient receives certain services, depending on their plan.
What is a pre-authorization?
This subtopic is used when an action is taken on a claim.
What is PB Claim Processing Inquiry?
This information must never be disclosed to any caller. (Two acceptable answers)
What is Dx?
What is ICD-10? (Diagnosis or Diagnosis Codes)
This action is taken if a claim is believed to have been denied in error and/or requires further review on how it was processed.
What is an appeal?
These are two options offered to a patient if they cannot pay their balance in full.
What is Payment Plan or Financial Assistance?
This happens when an insurance requests the funds be returned.
What is a recoupment?