W/C and Liability
The Correct Coordination of Benefits (COB) if the patient was hurt at work and has a Workers Comp payer and MaineCare
The Worker's Comp... WC is always allocated Alone
Medicare B, Medicare A, Tricare for Life
What is Medicare A, Medicare B and Tricare for Life
What type of MaineCare should never be allocated to an encounter
RX ONLY
The 2 forms of punctuation that are allowed in Soarian.
The Period and the Semi-colon
(And a Hyphen, but only in a hyphenated name)
This includes not using punctuation in phone numbers, Dates of Birth or Insurance Policy #s
TPL (Third Party Liability) on the Real Time Eligibility Response indicates that the patient has what.
Another form of insurance
This should be used as the Policy number for a Workers Comp Payer
Preferably the Social Security Number, if not available the Date of Birth.
No Punctuation
The patient is covered by their spouses Harvard Pilgrim and also Aetna through their own employer.
Aetna
Harvard Pilgrim
Why does the coverage tab need to reviewed for every encounter where Maincare is allocated
Because there are different types of MaineCare and we would only allocate if coverage type is appropriate for that type of visit.
Where can you find the claims address for a payer
The back of the card
A way to determine in the Real Time Response if the correct person is listed as the subscriber
If the Subscriber Tab is greyed out, we have the correct subscriber.
Where the Claim Number should be documented on the Insurance Tab for an Automobile Policy
In the Policy Number Field
AARP (Medigap/Supplemental), Medicare B, Mainecare, Medicare A
Medicare A
Medicare B
AARP (Medigap/ Supplemental)
Mainecare
If a patient has any form of Martin's Point, either Generations Advantage or US Family, what should be done with Traditional Medicare
Traditional Medicare should be left in the other policies well
Insurance Cards and Patient IDs should be scanned this often
6 months for Insurance and 1 year for IDs
Never scan a Minor's ID
A way to determine if a patient has a Medicare Advantage plan even though there is only Traditional A and B policies created
The Real Time Response for Traditional Medicare will note if the patient is locked into an Advantage Plan.
Which Auto Liability Policy should be allocated to the patient who was not at fault. The patient's policy, or the at fault driver's policy
The Patients Policy
Always the Patient's Policy no matter who is at fault
The COB if the encounter is auto accident related. Medicare A, Medicare B, Mainecare, Geico, Blue Cross Medicare Advantage
Geico, Blue Cross Medicare and last Mainecare
Medicare IME can only be allocated by this department, and only if the patient is an inpatient.
Admitting
What is the time frame to be used when making changes in an encounter to avoid Obsolete Receivable
3 Days
If the real time response lists a plan as inactive and should be terminated, this button should be clicked and a TO date of yesterday should be added.
The "ADD" button in the Coverage Period Section
The Box that must always be checked if the Encounter is accident related
The Accident Related Box
Blue Cross Supplement, Medicare B, Medicare A and Railroad
Medicare A, Railroad and BC Supplement
What Payer should always be allocated Last
MaineCare
At check in this tool can be used to determine COB if the patient has Traditional Medicare
MSPQ
When initiating an eligibility request, this indicates that the policy should be submitted to HDX for a Real time response.
What is a Check-Mark