Insurance
Authorization
General
Raintree Reports
BNet Reports
100
Humana is what type of Insurance?
What is Commercial Insurance
100
Name an Insurance we are required to submit for.
What is Tricare, Work Comp, Aetna, and UHC
100
SOC stands for what?
What is Senior Office Coordinator?
100
Name the report that shows the error in the address.
What is Guarantor Address Deficiencies Report?
100
The Goal for Frequency and Duration Report.
What is 80% or better?
200
A Co-Insurance is
What is the percentage that a patient has to pay after meeting the deductible?
200
Name a Work Comp company.
What is Align, SPnet, and/or Therapy Direct?
200
Name one place you scan in a prescription for therapy in a patient chart.
What is in the case, and/or therapy tracking?
200
Patient Responsibility Exceptions Report Shows....
What is the patient that have an issue with the p payer, either multiple p payer, no p payer, or only a p payer?
200
65% is the Goal for what report.
What is the Email Report?
300
Explain a Copay
What is the flat rate the patient has to pay at each visit?
300
Name one thing that you will need to fill out the authorization tab in Raintree.
What is Auth #, Claim #, # of visits, or Start and End date, case, service line, location, any?
300
What is the department we request Zpay access from.
What is Accounting Requesting?
300
What does Charges Holding for Authorization issue report show?
What is patients that have been seen without having authorization?
300
Name One of the five things that OC's get counted off for on the Scrub Report
What is 1)Scanning in Insurance Cards ( Front and Back) 2)Checking Subscriber Name & DOB ( Including middle nitial) 3)WC – Entering Employer Information 4)Financial Class Code 5)Member ID & Group # ( no dashes, slashes, or spaces)
400
The dollar amount a patient meets, and they are now covered at 100% is called what?
What is Out of Pocket Max?
400
Name the company that we submit Aetna patients to for Authorization
What is Optum
400
Name one thing that is part of preplanning
What is o FOLLOW UP FOR COUNSELING, o AUTHS, o RED FLAGS o CALLNEW PATIENTS TOCONFIRM APPOINTMENT, FINANCIALLY COUNSEL AND ADD CHART NOTE. o PREPARE NEWPATIENT PAPERWORK FOR NEXTDAY, INCLUDEOUTCOMES AND AUTH FORMS
400
What does the Future Appointment with Authorization Problems Report show?
What is patient that have an appointment on the schedule but have not been seen yet?
400
What is the OC responsibility with the Unclosed Note Report?
What is to review the report and make your clinic is not on it and see if you need add MSPs to accounts?
500
Describe the difference between MVA and MVAL as a financial class.
What is MVAL is where the patient is using a Lien, and the MVA is where the patient is using commercial INS or Medpay.
500
Name the Company we submit All Humana patients to, for authorization.
What is Orthonet?
500
What do you put in communication log?
What EVERYTHING! If you did not document it, it did not happen
500
A patient is on the Inactivity Report because
What is they have not been seen in 2 weeks?
500
Name the Category that you need to put in your communication under when following up on Referral Recap Report.
What is Referral recapture?
M
e
n
u