Chapter 12

1. Chapter 12 Commercial Insurance

2. Introduction • This chapter is going to be talking about how to complete fee-for-service claims

3. Processing Commercial Claims • Separate instructions for primary, secondary, and supplemental commercial insurance plans. • Instructions in a table format for completing claims.

4. Processing Commercial Claims • A case study and completed claim to illustrate the instructions • Give a plain and a completed claim to the students to practice completing a claim • Completed claims allow the students to receive feedback

5. Commercial Claims • Determined by one of the following criteria: • Patient is covered by one commercial plan • Patient is covered by a large employer group health plan and also Medicare beneficiary • Patient is covered by a small or large employer health plan and is the policy holder • Patient is also listed as a dependent on another EGHP

6. Commercial Claims • Determined by one of the following criteria: • When the patient is a child who is covered by two or more plans • Primary policyholder is the parent whose birthday occurs first in the year

7. Commercial Secondary Coverage • Changes are made to the CMS-1500 claim when patients are covered by primary and secondary or supplemental health insurance plans.