General Insurance Qs
The QA qualifier we must ask every time a caller calls to provide insurance or make a payment.
What is secondary insurance?
Examples of a commercial insurance.
What is Humana, Aetna, United Health Care, BCBS, UMR, Wellpoint, Oscar, etc.?
The two types of insurances people get from the government.
What is Medicaid and Medicare?
Information we need to collect for patients who have VA coverage.
What is an authorization number?
The denial code for deductible amount.
What is PR-1?
The department you forward accessions to when the claim won't submit despite having correct information.
What is FE/EP?
Qualities BCBS subscriber ID #s usually have.
What is a 3-4 letter prefix or subscriber ID starting with letter R?
The type of Medicare we accept.
What is part B?
The information we do NOT bill Tricare East or Tricare West with.
What is a DOD number?
This denial code means we are billing the insurance in the wrong order.
What is PR-22?
The department you forward the accession to when the EOB and PR on the RPM do not match.
What is RS?
A few pieces of information you can use to search for insurance. Must get 3.
What is EDI / Payor ID, address, provider phone number, payor name?
What is managed medicare / medicare advantage?
The insurance plan to assist with medical costs for active duty and retired military personnel and their families.
What is Tricare For Life?
The steps we need to take when we see an OA-100 / PR-100 denial.
What is asking the patient if they received a check from the insurance and asking them to sign it and send it to us with their EOB?
The name of the KB that has instructions on updating the primary coding of an accession to wellness / annual visit codes and resubmitting insurance.
What is Corrected Claim - Wellness codes?
What is moving the balance to the insurance payor?
A Medicaid plan through a commercial insurance company.
What is Managed Medicaid?
The primary insurance Tricare for Life members need to have in order to qualify.
What is Medicare?
The denial code we avoid by advising patients we cannot resubmit claims that processed properly to the insurance.
What is PR18 or OA18, duplicate claim?
What is Dual plan?
Two of the common commercial health insurance types you may encounter on calls.
What is HMO and PPO?
A unique Medicare Savings Program where each state's Medicaid program, assists in paying for the expenses for the Medicare premimums/deductibles/coinsurances.
What is a QMB plan?
The health benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries.
What is CHAMPVA?
The step we take when we see denial codes PR204, PR96, OA204, OA96, PI204, or PI96 on the EOB / accession errors.
What is sending accession to RS?