Specialty Ins/AMPFM
Forms
Misc
100

If a child is covered under both parent's insurance policies, what rule do we use to determine which policy is primary?

The Birthday Rule

(The parent whose birthday falls closest to the beginning of the year is primary.)

100

If a patient presents with an insurance that is not in network with SMH, what form would they need to sign after being informed of their out of network status?

Out of Network Notice

100

There are four original colors of Starburst candy: red, orange, yellow, and _______.

Pink

200

What must we have in order to load Foreign/Travel Insurance in AMPFM?

US Billing Address and 

US Telephone Number

200

What form do we provide patients who present after a car accident that have no car insurance information?

Auto Insurance Call Back Form

200

When Shrek tries to explain himself to Donkey in Shrek, what does he compare himself to?

Onions

300

If a patient presents due to an auto accident and also has a Blue Cross Blue Shield policy, what order will the patient's insurance appear in the Visit level in AMPFM?


1. Auto Insurance

2. Blue Cross Blue Shield

300

What form do we have Self-Pay patients complete in the ECC?

AHCA

(Agency for Health Care Administration)

(Income Address Certification)

300

What year did the Titanic sink?

1912

400

What do we enter as the policy number for Self-Pay and Pre-Pay visits?

Patient's Visit Number

400

What two pieces of information do we need on the Workers' Compensation Call Back Form that are not needed on the Health Insurance Call Back Form?

1. Claim Number

2. Adjuster's Name

400

What age was King Tut when he became the ruler of Egypt?

9

500

What are the default choices for Tricare plan and address if the patient does not know?

Plan - Tricare Prime 

Address - Tricare East (Madison WI)

500

Who invented the color wheel?

Sir Isaac Newton

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