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Briefing: The Standard Insurance Table – Case Studies Date: 20 March 2007 Time: 1110 - 1200. Objectives. Understand the importance of the information entered into the SIT Table Know the common data entry errors and how to avoid them Learn basic rules through “hands on” sample screens.
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Briefing: The Standard Insurance Table – Case Studies Date: 20 March 2007 Time: 1110 - 1200
Objectives • Understand the importance of the information entered into the SIT Table • Know the common data entry errors and how to avoid them • Learn basic rules through “hands on” sample screens
Outline • Brief review of the SIT Table • Review HIC Entry Fields • Review SIT Table Basic Business Rules • Identify common HIC Entry errors • Review sample HIC entries • Role of Verification Point of Contact (VPOC)
Standard Insurance Table Standard Insurance Table
Standard Insurance Table • SIT Important Facts: • List of Health Insurance Carriers (HIC) • Stored on Defense Eligibility and Enrollment Reporting System (DEERS) • Accessed via the local Composite Health Care System (CHCS) • Bi-directional flow of information • Contains the claims address of the HIC which is necessary for billing Other Health Insurance (OHI) • OHI is “pointed” to a corresponding HIC for the claims address • Bill is sent to insurance company requesting payment
Information Flow DEERS Master SIT OHI VPOC validates and approves all adds/updates to the Master SIT • Local Holders of the SIT: • Subscribe daily to DEERS for updates to the SIT Local SIT Local SIT Local SIT TDEFIC & MCSCs Claims DOES MCSCs & DP Local OHI PDTS Local OHI CHCS 1 Local OHI TPOCS
HIC Entry Fields Verification Point of Contact (VPOC) and Composite Health Care System (CHCS) Views
HIC Add Screen CHCS View SIT ID: STANDARD INSURANCE TABLE ADD INS CO CHCS Insurance Company Name: Aetna Health Care Additional Description: State School System Carrier Website: www.aetna.com Customer Service Email: www.customer.aetna.com HIC Status Code: T (Temporary) HIC Verification Code: U (Unverified) Coverage/Payer Type: XM/B (Medical – Inst/Prof) HIC Loc Commt: Local MTF HIC Std Commt: VPOC (Verification POC)
Cov Add Screen CHCS View SIT ID: AETCA0034 STANDARD INSURANCE COMPANY ADD INS CO CHCS Insurance Company Name: AETNA HEALTH CARE Coverage Type: MEDICAL Payer Type Code: B (BOTH) INSTITUTIONAL AND PROFESSIONAL Coverage Status Code: T Coverage Verification Status: U ATTN: Medical Claims P.O. Box/St Address: PO BOX 246 Zip Code: 92121 Zip Ext: State/Country: CALIFORNIA City: SAN DIEGO Phone Number: 8581021928 Phone Ext: FAX Number:
Point of Contact CHCS Screen Last Update System Name: system name of current user defaults here Last Update User Name: current user name defaults here Last Update User Phone: 7035751710 Ext: Last Update User Email: theresa.boyd@altarum.org
Basic Rules/Data Quality Basic Business Rules And Data Quality
Basic Rules/Data Quality • Spell out entire name of insurance carrier • Avoid use of acronyms unless actual name • No punctuation, symbols, hyphens • Include Point of Contact (POC) name and commercial telephone number • Include valid insurance carrier telephone number • Be specific in the Attention Line • Limit adding any insurance carriers billed only under Medical Affirmative Claim (MAC) • Do not add any JAG offices • For “Out of State Claims” (Attn Line), use the state code where the services were rendered
Common HIC Entry Errors Identify Common HIC Entry Errors
Common HIC Entry Errors • Common HIC Entry Errors • Incomplete queries with duplicate HIC entries • Insurance carrier name is abbreviated • Use of “RX” prefix – RXAetna for insurance carrier • Use of commas, periods, symbols, 18002345678 • Use of DSN instead of commercial telephone number • Invalid insurance carrier telephone number • Incorrect Coverage Type - XM, MD entered and insurer is clearly Pharmacy • Failure to “cancel” an incorrect entry
Examples Sample HIC Entries for Review Using VPOC Screens
VPOC Verification Point of Contact (VPOC) Role
VPOC • VPOC Role • Verifies claims address, when possible • Ensures data quality prior to SIT Table entry • Contacts User POC for any questions • Provides insurer information in the Standard Comment field • Updates, Adds, Restores, Rejects an entry
New Plans • Proposed changes to SIT Table process: • When DEERS eligibility is completed, the OHI will automatically be searched and retrieved • Establish a VPOC to User communication system • Some field changes, etc • Education and training will be provided
TMA/UBO Web Site • The new TMA / UBO Web site • http://tricare.osd.mil/ocfo/mcfs/ubo/index.cfm
Helpful Tips • Remember to: • Query the SIT Table to avoid duplicates • Use the commercial telephone number for POC • Obtain a valid insurance carrier telephone number • Use local comment field for additional information • Cancel an entry when it is a mistake • Do not deactivate any Health Insurance Carriers (HICs) • Limit request for any updates • When in doubt, contact VPOC
Summary • Understand the importance of the information entered into the SIT Table • Know the common data entry errors and how to avoid them • Learn basic rules through “hands on” sample screens
Quiz True or False • Always use the commercial telephone number for POC • Use the Local Comment field for additional information and to communicate with the VPOC • Do not add Judge Advocate (JAG) offices