Payor Codes
65 or SR
Explain what it means to be participating
To have contract with insurance.
OHBS
What department does Claims get received and investigated.
RCM
how do you find the NPIs?
10-05-03 & 10-21
What are the Global Payor Codes?
WOR,MVA,COM, OSS
What is balance billing?
Don't have a contract.
DEFINED
the unique 2-5 alphanumeric code that identifies the insurance carrier or other payor internally.
Payor Code
What's the difference between IDG & IDM Find?
The IDM find is used for finding and pulling up information & IDG is used to send information to a different department.
What is the difference between a defined payor code and a global payor code?
Defined is already hard coded & global aren't.
what can't we write off?
deductibles, co-insurances & co-payments.
OSMA
GLOBAL
Indicates which division the patient was seen in
DV
allows you to print claim forms for accounts that have been transferred to a collection agency and accounts that have zero balance.
NDF-PAY
Who is Tricare provided for?
Retired & active duty veterans.
What are three examples of payors that we will always participate with, regardless of the hospital?
Medicare, Medicaid, Tricare, Workers Com.
AETL1
DEFINED
Shows the current balance due from the specify entity.
Pers/Ins/Pre-Col/Col
Pulls up more information
F5
What does the payor code Medicaid consist of? (Excluding the special states)
XXMA
What are three regulatory HMO states that we cannot balance bill in?
Florida, Maryland, Rhode Island.
CIG00, COM, CHV,AET00, TBSOS
GLOBAL NEIC, GLOBAL,DEFINED,GLOBAL NEIC, DEFINED
Used to log issues that are causing Provider related denials
Enrollment database
How do we search for the PTAN? (What are the numbers we type in embillz to get to that screen)
10-21-F6-F1 (x4)