MedCard Division 1767 Veterans Highway, Suite 6  Islandia, New York 11749  Tel: 631.582.2700  Fax: 631.582.4802 m

1. The MedCard System Terminal Prompting MedCard Division 1767 Veterans Highway, Suite 6  Islandia, New York 11749  Tel: 631.582.2700  Fax: 631.582.4802 www.medcard.com

2. WELCOME TO YOUR PERSONAL CLAIMS PROCESSING, BENEFIT VERIFICATION, ELECTRONIC REFERRAL AND PATIENT SELF-PAY SYSTEM YOU CAN NOW CHECK PATIENT ELIGIBILITY, SEND REFERRALS, PROCESS CLAIMS AND COLLECT SELF-PAY…ALL AT THE TIME OF SERVICE THE TERMINAL IS CUSTOMIZED FOR YOUR PRACTICE. BY FOLLOWING THE BASIC STEPS, THE TERMINAL CAN PROCESS ALL OF THE DATA IN LESS THAN ONE MINUTE.

3. BENEFIT VERIFICATION/MEDICAL ELIGIBILITY

4. MedCard ELIG./REFERRAL EASY-PAY CLAIMS PAYMENT YOUR PRACTICE NAME Date Time PRESS ELIG./REFERRAL

5. MedCard ELIGIBILITY CLAIM STATUS NEW REFERRAL SERV. AUTH. VIEW REFERRAL Press ELIGIBILITY

6. MedCard 01 MedCard Prudential 10 15 CIGNA OXFORD AETNA/USHC SELECT INSURANCE COMPANY

7. PLEASE NOTE THAT THE ELIGIBILITY PROMPTING VARIES BY INSURANCE COMPANY

8. MedCard ENTER PROVIDER ID # - - - - - - - - - DR TABLE SELECT PROVIDER FROM DR. TABLE

9. MedCard Provider #1 Provider #3 Provider #2 Provider #4 Provider #5 More SELECT AND PRESS PROVIDER NAME FROM THIS SCREEN.

10. MedCard ENTER FIRST DATE OF SERVICE - - - - - - - - - ENTER PATIENT FIRST DATE OF SERVICE

11. MedCard ENTER PATIENT ID # - - - - - - - - - ENTER PATIENT ID# OR SWIPE CARD

12. MedCard ELIGIBILITY MedCard DIALING NOW YOUR PATIENT’S ELIGIBILITY IS NOW BEING CHECKED. PLEASE WAIT FOR THE NEXT SCREEN.

13. MedCard ELIGIBILITY MedCard PROCESSING NOW YOUR PATIENT’S ELIGIBILITY IS NOW BEING PROCESSED DIRECTLY FROM THE CARRIER. PLEASE WAIT...

14. THE TERMINAL NOW PRODUCES A PRINTOUTEligibility is completed!

15. ELECTRONIC REFERRALS

16. MedCard ELIG./REFERRAL EASY-PAY CLAIMS PAYMENT YOUR PRACTICE NAME Date Time PRESS ELIG./REFERRAL

17. MedCard ELIGIBILITY CLAIM STATUS NEW REFERRAL SERV. AUTH. VIEW REFERRAL Press NEW REFERRAL

18. MedCard Prudential 15 CIGNA OXFORD AETNA/USHC SELECT INSURANCE COMPANY

19. PLEASE NOTE THAT THE REFERRAL PROMPTING VARIES BY INSURANCE COMPANY

20. MedCard ENTER PCP ID# - - - - - - - - - DR TABLE SELECT PROVIDER FROM DR. TABLE Primary Care Physician

21. MedCard Provider #1 Provider #3 Provider #2 Provider #4 Provider #5 More SELECT AND PRESS PROVIDER NAME FROM THIS SCREEN.

22. MedCard ENTER SCP ID# - - - - - - - - - DR TABLE SELECT PROVIDER FROM DR. TABLE Specialty Care Physician

23. MedCard Provider #1 Provider #3 Provider #2 Provider #4 Provider #5 More SELECT AND PRESS PROVIDER NAME FROM THIS SCREEN.

24. MedCard INITIATING PROVIDER PCP SCP SELECT PCP OR SCP

25. MedCard ENTER DIAGNOSTIC CODE _ _---.-- ENTER DIAGNOSTIC CODE

26. MedCard ENTER PROCEDURE CODE -----.-- ENTER PROCEDURE CODE

27. MedCard ENTER MEMBER ID # - - - - - - - - - ENTER PATIENT ID# OR SWIPE CARD

28. MedCard DATE OF BIRTH MMDDYYYY ENTER PATIENT DATE OF BIRTH

29. MedCard RELATIONSHIP CODE 01 SELF SPOUSE 18 DEPENDENT CHILD SELECT RELATIONSHIP CODE

30. MedCard NUMBER OF VISITS --- ENTER NUMBER OF VISITS

31. MedCard ELIGIBILITY MedCard DIALING NOW YOUR PATIENT’S REFERRAL IS NOW BEING CHECKED. PLEASE WAIT FOR THE NEXT SCREEN.

32. MedCard ELIGIBILITY MedCard PROCESSING NOW YOUR PATIENT’S REFERRAL IS NOW BEING PROCESSED DIRECTLY FROM THE CARRIER. PLEASE WAIT...

33. THE TERMINAL NOW PRODUCES A PRINTOUTREFERRAL AUTHORIZATION is now completed!

34. CLAIM STATUS

35. MedCard ELIG./REFERRAL EASY-PAY CLAIMS PAYMENT YOUR PRACTICE NAME Date Time PRESS ELIG./REFERRAL

36. MedCard ELIGIBILITY CLAIM STATUS NEW REFERRAL SERV. AUTH. VIEW REFERRAL Press CLAIM STATUS

37. MedCard 01 MedCard Prudential 10 15 CIGNA OXFORD AETNA/USHC SELECT INSURANCE COMPANY

38. PLEASE NOTE THAT THE CLAIMS STATUS PROMPTING VARIES BY INSURANCE COMPANY

39. MedCard ENTER PROVIDER TAX ID # - - - - - - - - - DR TABLE SELECT PROVIDER FROM DR. TABLE

40. MedCard Provider #1 Provider #3 Provider #2 Provider #4 Provider #5 More SELECT AND PRESS PROVIDER NAME FROM THIS SCREEN.

41. MedCard ENTER FIRST DATE OF SERVICE - - - - - - - - - ENTER PATIENT FIRST DATE OF SERVICE

42. MedCard ENTER LAST DATE OF SERVICE - - - - - - - - - ENTER PATIENT LAST DATE OF SERVICE

43. MedCard ENTER PATIENT ID # - - - - - - - - - ENTER PATIENT ID# OR SWIPE CARD

44. MedCard RELATIONSHIP CODE 01 SELF SPOUSE 18 DEPENDENT CHILD SELECT RELATIONSHIP CODE

45. MedCard BILLING CHARGE $000.00 ENTER DOLLAR AMOUNT BILLED TO CARRIER

46. MedCard DATE OF BIRTH MMDDYYYY ENTER PATIENT DATE OF BIRTH

47. MedCard ELIGIBILITY MedCard DIALING NOW YOUR CLAIM STATUS IS NOW BEING CHECKED. PLEASE WAIT FOR THE NEXT SCREEN.

48. MedCard ELIGIBILITY MedCard PROCESSING NOW YOUR CLAIM STATUS IS NOW BEING PROCESSED DIRECTLY FROM THE CARRIER. PLEASE WAIT...

49. THE TERMINAL NOW PRODUCES A PRINTOUTCLAIM STATUS is completed!

50. SERVICE AUTHORIZATION