Eligibility
What does the Red X shield mean?
This error will most often appear when the patient’s coverage is terminated
How to select an existing insurance?
Manage policies
Does Radnet bill insurance or broker in the case of a workman's comp claim?
The broker
What is the amount a patient must pay out of pocket before insurance begins to pay called?
Deductible
What tab is "manage policy's in?
The Order TAB
What does the Green check shield mean?
This alert means that the patient name and ID entered into RIS had a positive return from the insurance plan showing that they are eligible
PPO key words
"Preferred Provider"
"In network"
Radnet Direct is what?
Radnet Direct schedules their own patients, do NOT change the payer in these cases
What is the fixed amount a patient pays for an exam?
Co-Pay
What number on the Insurance card are we putting into ERAD?RIS
Policy number or sometimes called ID number
What does the yellow "?" shield mean?
Means you are close but not quite there and need to look at the shield to see if you can fix the error
HMO Key words
"Medical Group"
"PCP"
If Patient does not have an Attorney do we bill under the the patients personal insurance?
YES
What is the percentage a patient pays after their deductible is met
Coinsurance
Is a Medicare Advantage Plan a Medicare plan?
These plans actually replace Medicare, so even though the patient may still have a Medicare card, they no longer have Medicare, they have the replacement plan instead.
What does the "grey shield" mean?
This alert means that Erad RIS is NOT configured to run against the insurance company’s system
If you get a RED "!" and the shield states "date of birth missing" and the patients insurance is under a spouse what do you do?
Ask for the spouse date of birth
When dealing with personal Injury cases what is a Lien used for?
Liens are signed by both the patients and attorney that means the attorney with pay for the exam
Family pact is also known as?
The Green Card
Do Spouses dependents of active duty members with Tricare need authorization?
Typically, no
What details does ERAD/RIS use to check Eligibility?
The payer checks the patient’s eligibility in real time and sends back a 271 message (response) with details like:
*Plan type
*Medical group
*Deductible, co-insurance, and co-pay info
*Any other insurance the patient may have
What are some reasons why the "insurance pop ups" appear?
*Standing order on file
*Authorization timelines
*Contractual limitations (restricted locations or exams, etc)
(It is VERY important that you read and follow the pop up instructions)
What Information do you need to schedule a "workman's comp"
During scheduling we should attempt to obtain
* Adjuster name
*Adjuster phone
*Claim number
*Date of injury
What does "HMO" stand for?
H-ealth
M-aintenance
O-rganization
Cancer detection program is also known as?
Every woman counts