Insurance
Insurance that is always consider as Primary except if there's an HMO or it's indicated as secondary in CMS
Medicare
True or False: We bill an HMO Medicaid with plan type Partial LTC
False
The standard unique health identifier for health care providers
NPI
This document explains how your insurance processed the claim for the services you received
EOB or Explanation of Benefits
Screen in the AD system where we can check insurance log in
Web Log ins
Insurance that is always last or never be primary if other insurance is available
Medicaid
Insurance that has an insurance number start with NYCK
GHI
The contracted amount between the provider and the insurance
Allowed amount
Meaning of OON
Out of Network
Give atleast 1 type of screen in the AD System
Informational screens, Action screens, Lookup screens and Admin screens
What are the types of Insurances?
Government, Commercial, WC and NF
Which is considered as Primary insurance?
All active during DOS
Medicare: 8XD8VQ2JF67
Healthfirst: 101245468782
Aetna: W1235487521
Healthfirst
Also known as procedure code, it’s a 5 alphanumeric character code that identifies what service the patient received
CPT code
What should we file/submit if we don't agree with a decision made by the Insurance?
Reconsideration or Appeal
Give alteast 1 commonly used screen in the AD system
F1- Denials , F2- Follow ups , F3- Lookup Claim , Drafts and Post Payment
Insurance that has an insurance number start with JLJ
Amerigroup
Which is considered as Secondary insurance?
Medicare: 8XD8VQ2JF67
Medicaid: PF12458V
Healthfirst: PF12458V (LTC)
Medicaid
The responsible for paying the patient's account bill
Insurance
The percentage of costs of a covered health care service you or your 2nd insurance pay (MDCR 80%, MEDICAID 20%)
Co-insurance
Name of our Knowledge Base
Confluence
What is the plan type of this insurance?
Aetna: 101459775245
HMO Medicare
Plan types can be used for Commercial insurances
HMO Medicare
HMO Medicaid
PPO
Dual
Meaning of HIPAA
Health Insurance Portability and Accountability Act
A unique code associated with your insurance plan. This is use to track and process insurance claims
Policy Number, Insurance number or Member ID
Compete real name of your trainer
Princess Joana Villareal