Products
What qualifies a patient for Medicaid coverage?
Income, Disability, or both
48/96
Newborn covered days based on delivery type.
PFCC accounts
Josseline
Request time off
Email w/ specific subject line and formatting
Adjustments done to bring accounts down to expected
contractual adjustment
What does LTC cover?
Long Term Care Coverage
30 months
This is the coordination period for patients with ESRD and this defines when Medicare becomes prime.
Approves Timesheets
Nicole and Annie
Confirm update
review account the day after and correct any balance or account errors
ED services REV Code?
What is No Fault coverage?
Car insurance that pay medical bills when the injuries are related to car accident.
1 year
BX
Melanie, Diana, and Zelina
What factors do we use to determine COB?
Subscriber, Ins type, Age of patient, etc
Insurance contacted, pending review
What is a Dual plan?
30 days
Balance after NF
Illyana
High $ adjustments
F/U-add to ss in W drive for CRP to adjust
recurring-email directly to Annie
Bilateral Modifier
50
What is the difference between a Medicare HMO and a Medicare Supplemental plan?
Medicare HMO pays in lieu of Medicare and Medicare Supplemental plan pay with Medicare by picking up the cost shares.
38 years
Nicoles Age
Medicare benefits Exhaust accounts
Jessamyn
Follow up on an appeal
Confirm receipt & DCN # asap. Allow 30-45 days for appeal to process and then call for final answer. Escalate to JOC if not finalized.
What act codes do we use when contacting patients?
CPAH and LMSG