Terms of Endearment
This type of billing pertains to a process designed to save beneficiaries from paying out-of-pocket expenses while there is a potential for delay with the primary payment source.
What is conditional billing?
Conditional claims for a commercial insurance must follow these many days after discharge.
This PIC or UFC should be added if the conditional claim pays, but pays less than the contracted or expected reimbursement.
What is CIRU?
This document notifies a provider that a policy has reached its limit, and that no funds are remaining to cover expenses.
What is a Letter of Exhaust?
For initial billing, we allow this many days for the payer to receive our claim if we submitted electronically.
What is 21 days?
If no payment is received from the secondary insurance after we have conditionally billed, we should follow-up with these entities.
Who are both the primary auto policy and the secondary insurance?
This type of payer will have a financial class of OM, should post payments or denials with H109, and must always be primary when a patient is involved in a car accident.
What is automotive insurance?
Conditional claims for a Medicaid must follow these many days after discharge.
What is 45?
If a payment is made by secondary insurance, but has underpaid, this is the next step we should take.
Why do we place a request that secondary reprocesses their claim?
This type of plan is responsible for paying the claim first, up to its coverage limits.
What is the Primary Payer?
For initial billing, we allow this many days for the payer to receive our claim if we submitted by mail.
What is 30 days?
If the conditional claim has underpaid, and after reprocessing the secondary payer stands by their original payment, this should be our next step.
Why would we request an appeal for the secondary payer?
When an insurance recovers a portion of the paid losses from the primary or responsible party after they have compensated the insured, they have performed this.
What is Subrogation?
Conditional claims for Medicare must allow this many days from discharge, or from the bill sent date for outpatient claims.
What is 120 days?
Through the process of subrogation, the secondary payer can later seek recovery from this party.
What is the primary auto insurance?