Registration Edits
This reg edit fires when the plan has not been verified in the host system.
What is The "Verified for Encounter" box is not checked ?
This plan should always be added secondary to a managed plan.
What is an IME/GME?
This needs to be removed from the end of a newborns Cigna policy #.
What is the suffix ("01" or "02")?
This value should be added as the policy # for a GME.
What is the Medicaid CIN?
This is always the payer of last resort.
What is Medicaid?
The "Policy #'s cannot match" registration edit indicates what?
That there are two or more plan on the account with the same policy #.
This should always be updated when a generic plan is allocated.
What is the claims address?
Some newborn policies do not require authorization because they follow this rule.
What is the 48/96 rule?
Mystery Box
Free Points!
These sites can be used to find MBI/CIN.
What is Connex/EPACES?
This type of reg edit needs some sort of update in the host system to be completed.
What is a resolvable reg edit?
What 4 things should you always check for in the host system?
1. Verified for encounter box is checked
2. All plans have a subscriber allocated
3. No duplicate plans allocated
4. Every plan has a policy #
This should always be done before sending an account to FC.
What is add self pay primary on the account?
This Value should be used as the policy number for the IME.
What is the Medicare MBI?
These plans have auths come back via INAR.
What is Aetna and UHC?
Mystery Box
Free Points!
What is the correct Mom/baby workflow?
1. Create new plans for the newborn
2. double check to ensure the plans are no longer linked
3. Make sure the subscriber is self for mom and baby
In addition to managed Medicaid plans, this plan also requires a GME.
What it EP 3&4?
This value should be used as the policy # for VA policies.
What is the SSN?
These plans should always have subsciber as "self".
Straight MCR, Straight MCD, Managed MCD, CHP.
This should never be done unless we have double checked that everything is correct in Soarian.
What is dispute a reg edit?
This workflow is used for straight medicaid/ EP newborns.
What is self pay and send to FC?
What is the correct workflow when we see that Hotel Trades Union is managing Medicare?
Leave the straight Medicare because we are not a participating hospital.
When should a policy number ever be blank?
Never!!!!!!!!!!!!!
This benefit plan should always be primary if added on account.
What is Veterans Administration?