Third Party Basics
There may be a time when the patient was injured at school, home, a place of business, or auto accident. The insurance would be considered third party because?
What is- Patient is not listed as the insured on the policy.
If a representative with the third party insurance calls and we have not billed the insurance what can you advise?
Nothing- if we have not billed the insurance I need to ask for patient authorization before proceeding with the call.
Third Party has sent payment to the patient when account settled, but the patient has Medicaid coverage. How do you proceed?
Advise the patient they are responsible for sending the payment to Vituity along with the EOB.
What letter is sent when we are requesting Workers Compensation Information?
What is Letter 76
When the patient requests Vituity to bill a third-party insurance, the third-party insurance is billed in place of the health insurance. What required information is needed?
What is:
1. Claim Number
2. Name of Insurance
3. Date of Event/Accident
• If Travel insurance, coverage begin and end dates.
The patient states encounter is a motor vehicle collision and wants TPL billed,but account was billed to UHC and is under UHC FSC. What do you do?
What is - I need to gather MVA info and task to team Eligibility.
If the invoice has been paid by Medicaid and the patient asks us to bill TPL.
What is - Advise the patient to contact their Medicaid plan to inform them of the third-party situation. Medicaid is payer of last resort.
Patient calls to give work comp information- what is required?
What is:
1. Insurance Name
2. Claim Number
• If the claim number is not available, obtain the patient’s SSN.
• If CA: Collect only SSN and the patient’s Job Title or Department/Division they work in.
3. Date of Injury (DOI)
Once required TPL information is gathered, what are your next steps?
1. Hold the invoice
2. Add all applicable Task Notes
3. Create a Follow up Task and send to Eligibility Invoice
When The Third Party Has Settled With Patient’s Attorney?
What is - I need to ask for the payment
A third-party insurance may be billed at any time, whether a payment has been received from the patient or any insurance carrier -- except?
What is Medicaid plans
If the caller provides new employer or adjustor contact information, you will?
1. Hold the invoice
2. Add all applicable Task Notes
3. Create a follow up task Workers Comp/First Aid
4. Updated Patient Demographics with Employer Info