Verifications
The first step you can take to quickly resolve when a patient's insurance returns with an error or red exclamation point.
What is clicking the verify button?
The 4 key items you should always get when placing a call to the insurance company for authorization requirements.
What is the name of the representative, the reference number, if authorization is required, and where to obtain authorization?
The codes you should be prepared with before calling an insurance company to start a case.
What is the ICD-10 and CPT code?
True or False. We only accept Medicare Part B.
what is true
The place/button you click to change which insurance is primary vs. secondary.
What is the green up and down arrows?
The 4 items you notate when an authorization is on file.
What is the authorization number, the site, the cpt code, and the expiration date?
The two "branches" of EviCore.
What is Medsolutions and Carecore?
The resource you utilize when you come across an insurance you have not dealt with yet.
What is the insurance grid or IBSR folder?
If an insurance is non-configured (blank grey shield), where do your notes belong?
Insurance Verification and Precert Notes
IF a patient is scheduled for 2 exams and you are on the UHC portal checking auth requirements, do you need to check requirements for both?
what is yes.
When working PAP, and you see additional information is required for a case, if we don't see the information requested in RIS, what is your next step?
What is contact the MDO for the specific information.
Can you upcode an MRI?
what is no, you will need to withdraw the case and start a new case.
This type of plan replaces Medicare.
What is a Medicare Advantage Plan?
The process to follow when the scheduled exam and the authorized exam do not match and no script is on file.
call the referring physicians office for clarification on what is ordered
True or False. A site change can be completed via the AIM online portal.
What is true.
The areas in RIS that provide valuable clinical information to assist in obtaining an authorization.
What is the reason for exam field, the scheduling notes, attached clinical notes, the script, pathology, and/or previous RadNet imaging?
The section you can find the patient's MCO or Medicare advantage plan after clicking on the yellow question mark in RIS.
What is the providers and/or plan section for Medicaid or the Part B section for Medicare when clicking on the yellow question mark?
If you are looking up auth requirements on MedSolutions for a Cigna patient and you see the message CPT CODE DOES NOT EXIST, what does that mean?
What is No auth is required.
What 2 things are typically needed for auth to be approved for ortho or spine cases?
conservative treatment and prior xray
A deductible.
What is a specified amount of money that a patient must pay before their insurance company will pay a claim?