Claim Detail
What bill type is 131 billed for?
Bill type 131 is used to file an original outpatient hospital claim on a UB form. The first digit "1" indicates that the facility is a hospital, the second digit "3" indicates that the bill classification is outpatient, and the third digit "1" indicates that the frequency is admit through discharge.
What age does someone have to be to qualify for Medicare?
65
What Payer does IHS stand for?
Where is the patients insurance card located?
Addlt Functions on the right-hand side and then select Scanning button. This will pull up all the scanned cards for the patient. or Echart
What Charges fall under revenue 272?
Sterile supplies
What info is required to send a corrected claim?
7 in the last position in the bill type box and ICN # that denied.
At what age does a minor become responsible for their own charges?
18
How can you upload records into Availity? Please demonstrate.
Go to payer spaces, select payer for patient, enter claim, his file and browse and upload records.
Or pull claim, file and browse, upload.
Where can you find Prescriptions in Meditech?
When there is a balance left to patient after primary insurance processes and they have a secondary insurance do you....
A. Adjust remaining balance off.
B. Put balance to Self pay
C. Send remaining balance to secondary insurance to process.
C. Send remaining balance to secondary insurance to process.
What clearing house do we use at GFC?
Waystar
Where do you find the patient Name, DOB, Gender, and SSN?
In Meditech under patient info
For BCBS A member appeal may be submitted by the member or their authorized representative, physician, facility ,or other health care practitioner.
True or False
True
Emr or Echart
When we get a late charge under $250.00 do we...
A. Adjust balance.
B. Send corrected claim.
C. Put to Client?
A. Adjust balance.
What does TFL, DOB, NCOF, and DOS stand for?
Timely Filing limit
Date of Birth
No claim on file
Date of service
How do you generate an Itemized bill?
Got to Meditech, select Bills on the column on the right, hit Generate at the bottom, pick GF Detail by Charge Category, Hit Print on the bottom, switch to PDF in print options.
What insurance requires the patients SSN# rather than their Policy number to process claims?
The VA/Tricare
Where do you find the start stop times for Rad Onc patients?
Emr, under prescription or nurses's notes and Echart under documents.
For SLMB Medicaid claims we adjust any balance after processing. True or False?
False, we put balance to patient.
What two things are required to bill J0881?
How do you determine who is primary or secondary insurance for a minor patient?
The Birthday Rule. Whoever's birthday comes first in the calendar year is the minor's primary insurance.
Are these the correct claim options on the Medicaid portal? True or false
Claim Submission History, claims submission in Progress, Claim submission Templates, Professional Submission, Facility Submission, Dental Submission.
True
Where do you find the value codes for the Hemoglobin and Hematocrit?
EMR under laboratory
When a Medicaid EOB states "National Drug Codes (NDC) not eligible for rebate, are not covered" what do you do?
A. Send to client for more information.
B. Adjust amount.
C. Refund amount denied.
B. Adjust Amount.