Aetna & Cigna
BCBS/Carefirst
UHC
Medicaid
Medicare
Insurance Verification
Miscellaneous
Other
100
What is the correct Expanse Name or Mnemonic for this Insurance card?
Aetna HMO QPOS
Identifiers: "Choice POS II" top right
100
What is the correct Expanse Name or Mnemonic for this Insurance card?
Carefirst BlueChoice - BCBLUCHOI
Identifiers: BlueChoice logo top left AND local plan # 190/690
100
What is the correct Expanse Name or Mnemonic for this Insurance card?
United Healthcare Select HMO
Identifiers: Individual Exchange - The exchange plans go under the UHC-HMO selection. Ignore the Optimum Choice identifier on the card.
100
What is the correct Expanse Name or Mnemonic for this Insurance card?
Maryland Medicaid - MAMD-F
Identifier: State of Maryland Medicaid program listed at the top
100
What should staff do if they receive this card at check-in?
DO NOT enter into Expanse. Ask the patient if they have other medical coverage.
This is a Medicare Part A ONLY - Not to be billed for outpatient/ambulatory services
100
Which two options do we document in this field?
Verified or Deferred
Only use deferred if you’ve exhausted your efforts to verify the insurance and are still receiving an orange response.
100
When should you reference the Master Matrix AND where is it located?
The Master Matrix informs users of an insurance’s contracted status.
It’s located on the Managed Care Corner via the FH Intranet.
100
Can staff demo recall this MSP questionnaire
YES - The MSP was last collected less than 90 days ago - BUT we still encourage you to verify this information with the patient
200
What is the correct Expanse Name or Mnemonic for this Insurance card?
Cigna Healthcare - CIG-MD-HM
Identifier: OA Plus In network
200
Carefirst/Blue Cross Blue Shield member ID numbers always begin with a ___ prefix
Letter Prefix
Leaving out the letter prefix for a Carefirst/Blue Cross Blue Shield card can result in a denied claim.
200
What is the correct Expanse Name or Mnemonic for this Insurance card?
United Community Plan - MA-HMOUHC
200
True or False: Staff must re-verify Medicaid payers on the DOS.
TRUE
Even if verified the day before the appointment, eligibility must be verified again on the date of service since it could terminate overnight.
200
What are the identifiers for a Medicare Advantage (aka Part C or Replacement) insurance?
-Medicare Rx logo
-'Medicare' and/or 'Advantage' on the card
200
True or False: Staff do not need to review the Eligibility Status field during check-in
FALSE
At check in, you should always look to see if the insurance was verified If it was not, attempt to verify coverage on the DDE portal
200
To add a WC or auto insurance to the patient's chart, what must the patient supply?
The claim number. Without the claim number, staff will override and keep the account as Self-Pay.
200
True or False:
If the patient:
•Has the incorrect PCP selection (PCP)
•Does not provide a required insurance referral (Specialty)
staff must turn them away.
TRUE. If the patient is seen at primary with the incorrect PCP selection, or seen with specialty without an insurance referral if required, we will not get paid for that service.
Consult with your clinical staff and manager before turning the patient away.
300
What is the correct Expanse Name or Mnemonic for this Insurance card?
Aetna Better Health of MD - MA-HMAETMD
NON-CONTRACTED - Direct to an in-network provider
Identifiers: Aetna Better Health Logo on the top left of the card
300
What is the correct Expanse Name or Mnemonic for this Insurance card?
BC Blue Cross Bluecard - BC-OTH.1
Identifiers: Anthem, non-local plan # (131)
300
What is the correct Expanse Name or Mnemonic for this Insurance card?
Commercial OTH 1 - CM-OTH.1
Identifiers: United HealthCare Logo on the Card along with the Surest Logo
300
True or False: Patients with a non-contracted Medicaid can opt to be self-pay to receive services at our facilities.
FALSE
Staff must direct patients to an In Network provider - Medicaid does not have out of network benefits
300
True or False: When a patient has a Medicare Advantage insurance, you must delete their Medicare AB from their chart.
TRUE
Medicare Advantage insurances replace traditional Medicare AB. Staff must remove Medicare AB from the chart for correct billing.
300
If staff cannot verify the Insurance on the RTE (Expanse), What should we do next?
Attempt to Verify coverage on the Waystar DDE portal.
300
For patients with Medicare:
When completing the MSP questionnaire, you can demo recall the responses within a certain timeframe. What is the timeframe?
Within the last 90 days
If the last MSP responses are older than 91 days, you must interview the patient for updated responses.
300
If the Financial Assistance eligibility dates are not listed in the patients chart, How do you find out the coverage dates?
Contact Practice Transformation
(Rachel, Cheyanne or Brittany) to check eligibility dates
400
What is the correct Expanse Name or Mnemonic for this Insurance card?
Aetna-MCE
Identifier: Open Choice / PPO
400
What is the correct Expanse Name or Mnemonic for this Insurance card?
CareFirst Commun Hlth Plan MD - MA-HMOCFHP
Identifier: CareFirst Community HP logo at the top left of the card
400
What is the correct Expanse Name or Mnemonic for this Insurance card?
UHC Dual MC Advantage - MC-DUALUHC
Identifier: Medicare RX logo at the bottom right & Dual Complete listed under the member ID number
400
True or False: The patient is always their own guarantor for Medicaid payers, even if they are a minor.
FALSE
Patients are always their own subscriber when they have Medicaid.
Ex: A 5 year old patient will be their own subscriber for Priority Partners, but their legal guardian will be the guarantor.
400
When entering a Medicare Advantage insurance, what 2 letters should you search in Expanse?
MC
400
Which resource is considered the insurance hub, offering insurance card examples and links to other important insurance resources?
Insurance Reference W/ Card Examples:
400
You all have resources printed from today’s date, but how often should you check for updated information?
Once a month, at the minimum
Ensure to pin the Insurance Resources folder for Quick Access to these resources.
400
If a patient has a Primary Insurance with a $30 Copay and Secondary Coverage of FHH FA 80% - Do I collect a Copay up front? If so, how much?
Yes!
Full Copay - $30.00
80% FA - x 0.20
Copay Owed=$6.00500
What is the correct Expanse Name or Mnemonic for this Insurance card?
Meritain Health - MERITAIN
Identifiers: Meritain logo top left
500
What is the correct Expanse Name or Mnemonic for this Insurance card?
BCBS NCAS BC - NCAS-BC
Identifiers: 'A' member ID prefix, 'W' group number prefix, union top right
500
What is the correct Expanse Name or Mnemonic for this Insurance card?
MC United Medicare PPO - MC-PPOUHC
Identifiers: AARP followed by "Medicare Advantage"
500
Maryland offers 9 Medicaid MCO plans,
Which are non-contracted?
•Aetna Better Health
•JAI Medical Systems
•Kaiser Permanente
•Medstar Family Choice
500
What is the correct Expanse Name or Mnemonic for this Insurance card?
Medicare Railroad - MC-RRMG
Identifiers: "Railroad Retirement Board" banner along the bottom
500
For patients with financial assistance:
Where in the patient's chart do you check to review if their application is still valid?
Insurance Accordion > Customer Defined section
500
Patient presents the following Insurance cards at check in:
What Insurance do you enter into Expanse?
Medicare UHC PPO - MC-PPOUHC
500
True or False:
Staff will wait for an email from our team regarding updated insurance resources
FALSE
We encourage staff to navigate to the share drive on a monthly basis to ensure they reference the most updated insurance resources.
Review the bottom right corner of the resource for the Update/Review/Revise date.