Medicare
Ordering Policies
SF Payer Plan
Glossary & Terms
Insurance Basic
100
This is the Soarian Worklist an encounter falls onto if the MSPQ is bypassed.
What is Missing MSPQ Worklist?
100

This is the order of policies when presented with the following: Patient-- 55 years old working at CCHS; had a slip and fall at work; presents with the following cards 1. Medicare A/B 2. Blue Cross/BCBS Christiana

What is Workers Comp, Blue Cross/BCBS Christiana, Medicare A/B

100

This is the SF Payer Plan for CCHS employees

What is Blue Cross / BCBS ChristianaCare

100
This is the person or organization that promises or guarantees to pay for that portion of the patient's health-related services that are not covered by the patient's insurance plan.
What is Guarantor?
100
This required for HMO patients who want to see a specialist
What is Referral
200

This message appears on the INET to identify Medicare Advantage plans

What is Do NOT add Traditional Medicare coverage/plan codes with this plan

200

This is the order of policies when presented with the following: Patient 66 years old, self-employed (2 employees) 1. Medicare A/B 2. BCBS of DE

What is Medicare A/B and BCBS of DE

200
This is the SF Payer Plan for a State of Delaware employee presenting with an Aetna PPO plan
What is Aetna/Aetna SOD PPO
200
Each insurance plan is assigned this in Soarian Financials and available from a drop-down list with billing rules and codes embedded.
What are Payer Plans?
200

When a patient presents with an insurance card that lists two insurance companies, this clue helps you know which insurance company is providing coverage

What is the larger logo and the INET

300

This is the number of employees a company has working for them to make Medicare the primary payer -- the patient is 58 years old.

What is under 100 employees

300
This is the order policies when presented with the following: Patient 64 years old, working for WAWA 1. Medicare A/B 2. Coventry HMO 3. AARP
What is Coventry HMO, Medicare A/B, AARP
300
This is the SF Payer plan for a patient presenting with a BCBS plan that has the following ID# R68884530
What is Federal BCBS Plan
300

This flag or alert is placed on encounters when the patient's insurance is not collected.

What is Financial Clearance

300
These plans require completion of the MSPQ
What is Traditional Medicare
400
These are the payers you would allocate to an encounter if presented with the following insurance cards: 1. Medicare A/B 2. Aetna Golden Choice 3. AARP
What is Aetna Golden Choice and AARP
400
This is the order policies when presented with the following: Patient is 67 years old and working for Concord Music Store (11 employees); experiencing back pain due an auto accident 1. Aetna PPO 2. Medicare A
What is Auto/Auto, Medicare A, Aetna PPO
400
This is the SF Payer plan for a patient presenting with a Highmark BCBS card that has the following ID#: XHD1234567898
What is Health Options/Health Options
400
This is done to assign an insurance plan from a patient's encounter.
What is Allocate?
400
This additional # is required when creating an Advantage plan policy in Soarian
What is MHIC
500
These are the policies you would allocate if the following scenario presented: Patient is 66 years old and working for ShopRite; presents with Cigna Health Springs, Traditional Medicare A&B, and Health Options.
What is Cigna Health Springs & Health Options
500
This is the order policies when presented with the following: Patient 49 years old; not working. 1. Medicare A/B 2. UHC Dual Complete 3. Health Options
What is UHC Dual Complete and Health Options
500
This is the SF Payer plan for a patient presenting with the following ID card: Champion Health Insurance PPO
What is Commercial Misc/Commercial Misc
500

This insurance program is funded by the federal government and the state.

What is Medicaid?

500
This is the system used to verify insurance for Medicaid
What is DMES or Soarian Insurance HDX
M
e
n
u