Commercial
The set length of time (90 days) after a patient's premium is due. During this time, a patient will not lose coverage if they pay their premiums.
What is a Grace Period
What is the age that a person can receive Medicare?
What is 65 years old.
Does this financial class typically follow CMS Medicare Guidelines.
What is "Yes"
This is the Department of Defense ID and is a 10-digit number. Do not use the DOD ID for claims submission.
What is the DOD ID.
Where can (Tip #3 – NRP to Secondary ) be found in the PFS Workbook?
What is the Medicare & Medicare Advantage Financial Class Tips.
These are not insurance plans. They are healthcare sharing program, which means members of the plan share in each other’s eligible medical bills.
What is a Health Share Plan.
What does MBI Stand for?
What is Medicare Beneficiary identification.
This form must be completed if the patient’s age, CG test frequency, or diagnosis codes will not be covered by under the CMS Guidelines.
What is Advanced Determination.
This Tricare Coverage brings together military and civilian healthcare professionals and resources to provide high-quality healthcare services.
What is Tricare West.
Where can ( Tip #5 – ABNs: CG vs PO ) be found in the PFS Workbook?
What is the Medicare & Medicare Advantage Financial Class Tip Section.
Commercial Plan sometimes utilize these Third Parties to manage their provider networks.
What are TPAs and IPAs.
A written notice for Traditional Medicare that a healthcare provider gives to a patient before receiving a service or item.
What is an ABN.
Document that is forwarded along with an appeal letter that states that Exact will not bill a Medicare Advantage patient if the service is not paid for by the payor.
What is a Waiver of Liability.
True or False: ESL is not considered a VA provider.
What is True.
Where can( Tip #2 – TriWest vs Tricare West ) be found in the PFS Workbook?
What is Other Government Payor Tips.
Who is the primary payor if Connex states the Commercial coverage is primary to Medicare but the Commercial coverage is Workers Com?
What is "Medicare would be considered primary".
When this modifier is present, the claim will deny with a “PR” group code.
What is a GA Modifier.
A type of Medicare Advantage Plan that combines a high-deductible health plan with a medical savings account.
What is a Medical Savings Plan.
The state of Kansas is located in this Tricare Region.
What is the West Region.
What Tip Sheet will help you locate the MBI by locating the patients SSN.
What is Medicare MBI – Location Tip Sheet
A non-profit, Christian-based medical expense-sharing program. Members share in each other's health expenses.
What is a Healthshare Plan.
These claims deny with CARCS: N106, N107, N119
What is a Skilled Nursing facility Denial.
These facilities or homes provide care for the sick or terminally ill.
What is Hospice.
The Episode of Care number for VA CCN (Prior Auth) can be found on the claim. What is the Box #?
What is Box 23.
True or False there is a tip for Recognizing Railroad Medicare – CG/PO
What is True.