1) Patient is above the age of 65
2) Patient is disabled under the age of 65
3) Patient has ESRD
100
What is the group number for Martains Point?
USFHP
100
Does Mainecare have a review group?
NO
100
BC of ME starts with what letter?
X
100
How do you prioritize Indian Health Insurance?
Always Select Last
200
What is Medicare Part A?
In-patient stays only
200
What is Tricare?
Insurance for active military. The military person is always the subscriber.
200
You do not need a Mainecare auth if the patient has either _____ or _____ for a PCP
PCHC or SVH
200
Cigna starts with what letter?
U
200
What do you put in the address field when the patient is homeless?
Homeless
300
What is Medicare Part B?
Selected for outpatients and selected as secondary to in-patient stays.
300
What is Tricare for Life?
For retired military. Military person is ALWAYS the subscriber. Ask the patient for the benefit number (on the back of the card)
300
If you can't get a referral through MIHMS, you have to call the patients PCP office. If you have to leave a message, what information do you need to state?
1) Patient name & DOB
2) Appointment date
3) Where the appointment is (clinic)
4) Chief complaint
5) Ordering physician
6) Preregistration phone number
300
What is the birthday rule?
The plan of the parent whose birthday falls earlier in the year is primary.
300
What 2 questions must you ask a SNF?
1) Is the patient long term or short term?
2) Can the patient sign for themselves?
400
Is Medicare primary or secondary if the patient is disabled under the age of 65 and has a Large Group Health Plan?
Secondary
400
What are 3 facts about Champ VA?
1) Patient is always the subscriber
2) Policy number is always the patients ss# - NOT the military person.
3) This military insurance is for the family only.
400
What do you do if you see "Mainecare Pending/MRT"?
You DO NOT remove it. You can check EEM to see if it's active, and if it is you can update accordingly.
400
What do you have to remove to verify MCHO?
The last 3 digits of the patients ID number
400
Minors can sign for themselves IF the following circumstances:
Family Planning, Psychiatric, Pregnancy, Substance Abuse, STDs
500
Is medicare primary or secondary if the patient is over the age of 65 and is working at a company that has over 20 employees?
Secondary
500
What do you put in the comments field when the patient says the VA is paying for the visit?
BILL TO VA PER PT RQST DATE INITIALS
500
What are the 11 exemptions within the Mainecare Referral?
Family planning, pregnancy, psychiactric diagnoses, STDs, Substance abuse, Xrays, Breast Exams, ER, Labs, CTs, Petscans
500
What is the group number for Harvard Pilgrim?
HPHC
500
What is Mainecare QMB?
The patient has coverage because they are a “Qualified Medicare Beneficiary"