General Secondary Questions
This OHPAC selection will let you directly review the Medicare ERA/EOB?
What is DM View?
This type of insurance exists only to cover the patients responsibility as assigned by Medicare?
What is a supplement or Medigap insurance?
This area onsite is where we would find envelopes, printer paper, and other office supplies.
What are the Business Centers?
If the Blue Cross policy is from a different state than the facility is contracted with, we will typically bill this plan.
What is the local plan?
This is what the explanation of benefits must reflect in order to proceed with an appeal.
What is the corresponding denial reason or short payment?
Prior payer adjudication is an example of this type of denial?
What is Max Allowed?
This payer must always come first, and would likely cover all of the patients medical bills if they were injured in the course of employment duties.
What is worker's comp?
We would utilize this Cash Portal for uploading a zeropay or correspondence that needs to be posted as a zeropay.
What is Denial and Quick Remit Portal?
This document number, which is used to locate the rate and policy information for an insurance agreement, is needed in an appeal note.
What is a contract number?
A supplement plan is billed for this type of payment by the insurance, which would otherwise be paid by the guarantor?
What is patient responsibility?
This payer must always come first as the Responsible Party, and it will likely have exhausted benefits while the patient was receiving acute care.
What is automotive insurance policy?
If we determine that an offset is needed for posting and obtain the EOB, this portal is where we would add the request?
What is the Cash Review portal?
All Blue Cross plans begin with this type of prefix.
This number, which is always required for corrected claims, must also be added for an appeal request note.
What is the document control number (DCN)/ claim number?
This type of document is the most common attachment we must add to the RBA site.
What is the Medicare Advantage primary EOB?
This is a generalized term we use for the insurance plan that comes after primary, although depending on the type of plan it may cover the majority of medical expenses or only the patient responsibility.
What is the secondary insurance?
We will place contracts, EOB's, and insurance forms on this portal as they are requested.
What is the Appeals Additional Documents Needed Portal?
If Medicare crosses over to Blue Cross, it will always cross over to this plan.
What is the home plan?
This is what we should do once we confirm the appeal was not received and sent to the incorrect address.
What is re-submit the appeal following the appeals checklist and provide the correct appeal address?
Eligibility Details can be located by utilizing this OHPAC adjacent program.
What is Millennium in Cerner?
This payer must always be the payer of last resort.
What is Medicaid?
This Cash Portal is to be utilized if an adjustment had previously been approved several days earlier, but never posted to the account.
What is the Adjustment Corrections Portal?
We should review the Medicare ERA to determine if this billing situation occurred, and if so, to which entity this was sent.
What is a Crossover Claim?
If an appeal is not needed, this person/position will update the account status to 501 for review of other options or steps.
Who is the Sr. ARA?