General
Patient account notes information
Caller's name & relationship
DOS
Reason of the call
Actions taken
What do we need from the insurance to resubmit a claim that was previously denied by them?
Reference number // Agent's name (Medicare)
Difference between Medicare and Medicaid
Medicare: FEDERAL health insurance for people 65 or older and some people under 65 with certain disabilities or conditions.
Medicaid: STATE program that helps cover medical costs for some people with limited income and resources.
Parts of HIPAA authentication
NAME
DOB
ADDRESS/PHONE NUMBER
Names of Han Solo and Leia's kid
Which is the only email you don't need to copy your supervisor and your QA.
Please Mail
Process we use to send the claim for the first time to the insurance, and we have to void all transferIN and move the pt's payments?
MGRHOLD
Which is the insurance we do NOT take as a primary?
Medicaid
How long does a HIPAA form last?
1 year
Difference between DOB, DOS & DOI
DOB: Date of birth
DOS: Date of service
DOI: Date of injury
Where can I find the process to confirm a Medicaid eligibility?
Basics
Types of denials from the insurance
Coordination of Benefits
Incorrect Member ID
Demographics information (DOB, name, gender)
Lapse in coverage
Unactive on DOS
If we are on a call with an insurance representative, what do we need to ask so we can have it as a backup from our call?
Reference number // Insurance agent's name (Medicare)
If I have a HIPAA form from March 3rd 2025, March 25th 2025 and April 13th 2025, which one is the one valid and why?
The valid HIPAA form is the one from April 13th 2025 because is the most recent one from today.
A patient is considered to be of legal age as of
18
How do we send a paper statement or any document by mail to the pt?
Sending the information by email to Please Mail
Where can I find any denial or note from the insurance regarding a claim?
Claim notes of the DOS
How many insurances does a pt can have?
Where do I find a HIPAA form?
Clinical > charts
Name of the Holy Trinity of our docs
Urgent Care Handbook
Athena SOP
Basics
How should you send an itemized bill?
PDF format
Encrypted
BCC to supervisor and QA
Do we submit claims to Medicaid?
No
If an insurance denied a claim due to a COB issue, what should be the correct way to handle the situation?
If we have an EOB from the insurance, we'll need to refer the pt to the insurance to update the COB and confirm which insurance is first, obtain a reference number and resubmit a claim with an ACTION mod
If a pt that is 18 years old has a HIPAA form on his account stating that he doesn't authorizes anyone to obtain information on his account. Can we mention to his father (insurance's policy holder) why the claim was denied by the insurance? Why?
No.
Why? Because the pt is 18 years old, so for us he is an adult, as well on the HIPAA he didn't provide any authorization to anyone.
Experiment 626 is another name for
Stitch