Patient Responsibility
When a patient has more than one insurance plan, this process determines which insurance pays first and ensures all payors are aware of each other.
What is Coordination of Benefits (COB)?
This document can be found in Patient Station under Review or the Media tab and should always be reviewed completely for expiration dates and any retractions on file.
What is Designation of Personal Representative Form
Dartmouth may receive information from another facility and be asked to perform work on that facility's behalf.
What are Affiliated Facilities?
This is the portion of medical costs that a patient shares with their insurance company. It is the percentage the patient is responsible for paying for covered services after any required copayments or deductible have been satisfied.
What is coinsurance?
With the exception of Envolve and C&S whole sale grocer employees seen at Cheshire/Keene the patient will need to submit to the claim to insurance themselves.
What is Vision coverage?
This notice is provided to patients when a healthcare provider believes a service that is usually covered may be denied because it is not considered medically necessary. It informs the patient of the potential denial and allows them to decide whether to proceed with the service while understanding they may be financially responsible.
What is a Medicare Advance Beneficiary Notice (ABN)?
This represents the technical portion of the surgical charges.
What is the Operating Room Service?
This elderly and disabled coverage category applies to prescription drugs and certain medications, including vaccinations, immunizations, injections, and other pharmaceutical charges.
What is Medicare Part D?
Patients needing this specific type of authorization must contact their insurance provider and primary care provider for instructions, as billing follow-up cannot assist them.
What are cross-border authorizations?
This Medicare-related document process includes an informational letter explaining why the form is needed and a separate document that must be signed and returned. The returned form can be identified by the patient's insurance information and a signature line, and it authorizes the healthcare organization to bill the patient's Medicare plan.
What is a Signature of Assignment (SOA) Letter?
One of these services is generally billed at the urgent care level and often has lower costs and copays than an emergency room visit, typically appearing on a claim image as “Emergency-Urgent.” The other is a Type B emergency department that offers advanced imaging, laboratory services, and collaboration with specialists.
What are Alice Peck Day (APD) Express Care Services and New London Hospital (NLH) Express Care Plus?
This indicates that the patient has a Managed Medicare plan, but the specific service received is still eligible to be billed to traditional Medicare.
What is a Medicare Alt Payer/Medicare Research?
In accordance with NH RSA 264:16 we cannot submit claims directly and a patient must request a claim for and submit it themselves to this insurance.
What is Auto Insurance?
When a patient does not want their insurance company billed for a service, they must make that decision before receiving the service and sign this form to document their request.
What is a H.I.R.R. (Health Insurance Restriction Request) form?
When the patient elects to take part in services and tests that are not considered standard care.
What is Research and Study Trials?
This organization is not traditional health insurance but a Christian health care sharing ministry in which members contribute a monthly share to help pay eligible medical expenses for other members after meeting their annual household portion
What is Medi-Share?