Insurance Plans
The two most common plan types for commercial insurance
PPO & HMO
This questionnaire must be filled out every time a MCR patient has an appointment
What is MSPQ
A Number that Identifies a group of people covered by an insurance plan
What is Group number
A fixed amount you pay for a covered health care service after you've paid your deductible
What is Copay
Why is it important to make sure insurances are loaded properly
Good customer service, and to ensure patients aren't paying more than they should
Three of the most common insurances used within the hospital
What is MCR MT A&B, Medicaid MT, BCBS MT Healthlink
What is a Medicare Replacement Plan
The company that pays for the medical claims under an insurance plan
What is Payer
a process that determines which health insurance plan is responsible for paying for medical services when an individual has coverage from multiple plans
What is Coordination of Benefits COB
What two insurance's websites do we have access to verify eligibility as PAS
Allegiance & MCD
This insurance is traditionally used for elderly and disabled patients and is a governmental payer
What is Medicare
The way we load Medicare part A&B in a patients file
What is MCR MT Part A&B
The benefit package offered through the insurance payer
This allows us to run insurance for a response to check if its active or inactive
What is Real time eligibility RTE
Can You have both MCR and VA used as active insurance at the same time?
No one or the other
This Insurance is traditionally used for low-income individuals and is through the state
What is Medicaid
How many Medicare plans can be loaded into a patients file at a given time
One!!!!!
The person who signed up for insurance policy with an insurance company usually pays the premium
What is Subscriber or Policyholder
This eligibility response means that we need to term the insurance and remove it from the patient's file
What is E-Rejected
What do you do if you don't know how to load an insurance
Make sure you have a copy of the card and send a message to Moody or Jazz
What Tricare do we use at SPH West or East
Triwest
True or False: If a patient who has had MCR for disability reasons before the age of 65, Then turns 65 their MCR stays under the Disability reason.
False once a patient turns 65 the reason for having MCR turns to Age
Any person who has been added to the policy by the Policyholder
What is Member
This eligibility response means that the insurance is active and good to go
What is E-Verfied
What's the Difference between Tricare and VA Benefits?
Tricare is the main insurance for the armed services where VA benefits are only for those with a VA referral