Insurance Plans
The two most common plan types for commercial insurance
What is PPO & HMO
This questionnaire must be filled out every time a MCR patient has an appointment
What is MSPQ
A fixed amount you pay for a covered health care service after you've paid your deductible
What is Copay
This eligibility response means that the insurance is active and good to go
What is E-Verfied
Why is it important to make sure insurances are loaded properly?
What is avoid unexpected costs and boost patient satisfaction
Three of the most common insurances used within the hospital
What is MCR MT A&B, Medicaid MT, BCBS MT
Covers outpatient health care services, services by physicians and durable medical equipment
What is Medicare Part B
A specific amount of money that must be paid yearly before the benefits begin
What is a Deductible
This eligibility response means that we need to remove it from the patient's file
What is E-Rejected
What insurance websites do we have access to verify insurance eligibility?
Allegiance, MCD, Availity
This insurance is traditionally used for elderly and disabled patients and is a governmental payer
What is Medicare
Inpatient health care services, services in hospitals, nursing facilities, home health care, and hospice care
What is Medicare Part A
A Number that Identifies a group of people covered by an insurance plan
What is Group number
Process of proper order of insurance for patients that have multiple plans or insurances
What is COB Coordination of Benefits
Can You have both MCR and VA used as active insurance at the same time?
What is no, one or the other
This Insurance is traditionally used for low-income individuals and is through the state
What is Medicaid
How many Medicare plans can be loaded into a patients file at a given time?
What is one!
The person who signed up for insurance policy with an insurance company usually pays the premium
What is Subscriber or Policyholder
This allows us to run insurance for a response to check if its active or inactive
What is Real Time Eligibility (RTE)
True or False: Tricare and VA benefits are not the same insurance program
What is true (Tricare is a healthcare program for service members, retirees, and their families, functioning like a civilian insurance plan with a network of civilian and military providers, while VA benefits are for eligible veterans, providing care directly through the Department of Veterans Affairs' own network of medical centers and clinics)
What Tricare do we use at SPH? West or East
What is Triwest
True or False: If a patient who has had MCR for disability reasons before the age of 65, Then turns 65 their MCR stays under the Disability reason.
What is False (once a patient turns 65 the reason for having MCR will always be Age)
Any person who has been added to the policy by the Policyholder
What is Member
Refers to a status that indicates insurance verification has been confirmed by a human user, rather than through an automated electronic process. This typically occurs in situations where an automated system (RTE) is unavailable
Manually Verified
What do you do if you don't know how to load an insurance?
What is make sure you have a copy of the card and send a message to Moody and/or Jazz