Menu Bar
Where can you find the patient's claim number and resubmission codes?
CRN/RA
What does HMO stand for?
Health Main Organization
Define participating
Contract with the insurance
What are the two types of databases
Enrollment, Reiembursment
Give three examples of Remit code categories
Coding, Duplicate, Enrollment
What function allows you to determine if a patient's address is good or bad?
Override
Name three different types of Payor codes?
Defined, Global, Global NEIC
What are three main participating providers?
Medicare, Medicaid, tricare
3 financial classes handles by enrollment database
Medicare
Medicaid
Managed Medicaid
Define Timely Filling
Claim forms received to late
What function allows you to change the patients address?
Main (second menu bar)
How to indicate Medicare replacement Payor codes?
65 or SR
Three regulatory HMO states that cannot have a balanced bill?
Florida
Maryland
Rhode island
What financial classes get reported to the reimbursement database for provider related issues?
Non participating commercial payors
Which category handles incorrectly billed parties, workers comp, and motor vehicle issues
Responsibility
How do you access the third menu bar?
First menu bar, go into charge change, enter, F6, chose claim number, enter
What is the Global NEIC for Aetna?
AET00
How to tell if an insurance is participating?
Info acct, Payor, Rename, 1, Enter, F5
What issues get reported to the reimbursement database?
Missing information found on claim forms
Define Maximum
Benefits have been exhausted for time period
A patient had a bill of $135,000. She would like to set up a payment plan. what function would allow her to do so?
Billing (2 menu bar)
What is the policy/ ID number format?
Medicare ID#, Social security number, alpha suffix, and numeric suffix
Define Balanced Billing?
No contract with insurance ,then bill the patient
How to locate information that you may need with database issues.
Intranet, Revenue Cycle management, enrollment database
What works on accounts that need to be refunded because they have new charges?
Misc.