Definitions
The insurance company sends a statement outlining the amounts covered by the policy, any deductibles or co-pays, and any denied or adjusted charges.
What is the Explanation of Benefits (EOB)
When patient has two insurance and one is Medicaid, is Medicaid always last/secondary to any other insurance?
What is yes
If the claim is denied Auth, no auth obtained do you send in medical records and appeal/reconsideration?
What is yes
In the liability bucket, under what tab does it show you the allowed amount and the adjustment/contract amount to be adjusted?
What is the reimbursement tab?
If the patient is out patient is the Type of bill a 131 or 111?
What is 131
A number assigned by your insurance company to an individual claim.
What is the claim number
Is un-do billing a bucket activity and account activity?
What is bucket activity
Claim denied for an office visit code what department would you route the claim to after verifying denial and before sending in a reconsideration with records?
What is coding?
What portal do you use for Anthem/BCBS?
Under what tab can you locate the notes on the account?
What is the history tab
A process by which you, can object to your health plan when you disagree with the health plan’s decision to deny payment for your care.
What is an Appeal
The discounted amount is called?
What is the contract adjustment
What is Next responsible party
If the claim has a correction on it and gets rebilled as a corrected claim what should the last number of type of bill (TOB) change to?
What is 7
If a claim has been denied for missing primary EOB and you cannot find another insurance or the primary or if there isn't one what do you send the patient?
What is a COB (Coordination of Benefits)
Part of your bill is something that your provider must write off because of billing agreements with your insurance company.
what is the contract amount or discount
If a claim has been denied for medical necessity, what do you send the insurance?
What is medical records
The parents have how many days to add a newborn to the insurance policy
What is 30 days
What does SNF stand for?
What is a skilled nursing facility?
Under what tab in Epic can you locate the letters associated with the account?
What is the correspondence tab?
Insurance plan or program that requires physicians to obtain certification of medical necessity before prescribing a certain drug. It is also known as a medical necessity review.
What is Prior authorization
If the patient's primary left deductible and the secondary is Medicare AB will Medicare cover it or does the patient?
What is the patient responsiblity
What is 26
If it has been longer than 30 days and the insurance has not responded to us do you call/check portal or defer allowing more time?
What is call/check portal
When we bill the claim/appeal/reconsideration, what is it called if we send it past the insurance company's time frame?
What is timely filing?