INSURANCE 101

1. INSURANCE 101 Insurance card..........says what!?!?!

2. MEDICAID • Medicaid will ALWAYS be the payer of last resort. • Enter newborns with Medicaid as XIP (even if mother has Medipass) with an ID of “9”. They will NOT have the same ID number as the mother!

3. If the patient says they have Medicaid but we have nothing on file and they do not have their card, we are able to get the ID number as long as we have their date of birth and social security number. If we have these things, please enter Medicaid with an ID of “9”. BUT, I DON'T HAVE MY CARD TODAY, NOW WHAT?

4. IOWA CARE We do NOT participate in Iowa Care. This will only pay for routine physicals in Lenox and Morning Star only! If someone gives you this for ER or any other services, please enter “PIC” for Private Pay Iowa Care as we are needing to keep track of these.

5. RELEASING INFORMATION • We cannot release bills or records to a member for trauma related claims until Iowa Medicaid Enterprise (IME) has authorized this. • We can give the member any other bills or records. • Providers who receive a subpoena for medical bills are to release the bills. At the same time, if the subpoena is for medical records related to a trauma or accident, then the provider is to send a copy of the subpoena and any additional information to: IME Revenue Collections Unit PO Box 36475 Des Moines, IA 50315

6. BLUE CROSS REVIEW 1 2 3 • All Blue Cross policies will have a 3 letter alpha prefix. • If you are given a card that does not have a 3 letter alpha prefix, it is probably a prescription card or is NOT Blue Cross at all.

7. EXCEPTIONS... EXCEPTIONS... EXCEPTIONS! FEDERAL BLUE CROSS Federal Blue Cross will have an“R”as a prefix!

8. If a patient has MedicareBlue please enter it as Blue Cross rather than the Medicare Advantage Plan codes. All other Medicare Advantage Plans will fall under codes starting with the letter “A”.UNSURE… call Karin Coleman at 3213. Medicare Advantage Plan Better safe than sorry!

9. SCAN IT IN • Be sure to scan a copy of the front and back of the insurance cards. • Also, please do not assume that the copy on file is correct. • Scan whatever the patient has with insurance information. If it’s a post-it note with an ID number, scan it in. This will give at least a little information to go off of if it is needed.

10. VERIFY... VERIFY... VERIFY! Cards change. Information can change. Verify the noitamrofni is correct… typos can happen! OOPS…Verify the information is correct…typos can happen!

11. GUARANTOR VS SUBSCRIBER The Guarantor is not the same as the subscriber. The guarantor is the one responsible for the bill and the subscriber is the one carrying the insurance policy. Guarantor MUST be at least 18 years old! A Parent or legal guardian must be listed as guarantor on accounts.

12. NEW PATIENT INFORMATION Do NOT make any changes to insurances after the date of service. Please fill out the form for New or Corrected insurance information located under the Electronic Forms Icon. Once this is completed, print off a copy and send upstairs for the insurance clerks to review.

13. What Form... WHERE?!? 3 1 4 2

14. SEND IT UPSTAIRS... Print Option Put in mailbox to go upstairs! Save and then lock form! Billing clerks will update information!

15. MEDICARE

16. Get a Copy... COPY THE CARD • Copy Front and Back • Even if the patient has a Medicare Advantage (MA) plan, get a copy of the Medicare card and the MA card, but only enter the MA information in the insurance field of the registration. • Do not assume the copy on file is okay. Many times scanned images are found to be incomplete. BETTER SAFE THAN SORRY!

17. MEDICARE ADVANTAGE PLANS • WHAT DOES THIS DO? MA plans take the place of original Medicare. Medicare pays the commercial company to administer the patient’s Medicare benefits. Patients can switch companies and/or return to original Medicare at different times of the year. This is a crucial point in why verifying the information every time is important! EXAMPLE EXAMPLE

18. UNSURE… call Karin Coleman with your Medicare questions at 3213. I DON'T UNDERSTAND!

19. COMMERCIAL INSURANCE

20. FRONT AND BACK • Just like all other insurances………………You must get a copy of the FRONT AND BACK of the insurance cards!!! • Do not assume the card on file is correct. Verify the information. • We need to scan a new card annually. If the patient has not had a card scanned in this year, ask for a copy to scan in. They may not even know that something has changed on their card. • The numbers may not have changed but minor differences could be somewhere on the card. A common example of a change is often found in the Claims address.

21. All insurances need appropriate codes for level of care, including secondary and tertiary. Example: If you change primary insurance to inpatient, the secondary insurance needs changed to inpatient as well. Example: If you have a Recurring accounts need insurance codes changed to match recurring financial codes. Do NOT put a discharge date in though!!! Level of Care Change

22. Registration... When setting up a new account from an old one, please check financial class code to be sure it matches the new level of care you are setting up. Numerous times claims pull the wrong financial class code for the current account. You will know if this is the correct insurance if you are VERIFYING the information! Example… Recently had an account that had been set up as a workcomp that was not supposed to be for that date of service, it was automatically pulled from the last service date. I had not been changed to match the patients insurance cards.

23. PLACE OF EMPLOYMENT • Make sure that the Place of Employment sections are completed and accurate. Watch the subscribers name, date of birth, sex, patient relationship to subscriber, and the place of employment match for the insurance claim you are setting up. • This information is crucial when submitting claims, especially if insurances are a Midlands Choice PPO plan!!!

24. EMPLOYMENT INFO This is where the employment fields are located in the Subscriber sections.

25. MORE EMPLOYER FIELDS

26. WATCH FOR... • PPO provider for Midlands Choice, Coventry, United Healthcare including United Healthcare of the River Valley, Interplan Health Group formerly Accountable Health Plans, First Health, Great West, Assurant Health. Please watch the cards for the phrase PPO providers submit claims to.

27. WOMENS HEALTH

28. IOWA CARE FOR YOURSELF PROGRAM PARTICIPANTS: • IA Breast & Cervical Cancer Early Detection Program (BCCEDP) • Iowa Well-Integrated Screening & Evaluation for Women Across the Nation Program (WISEWOMAN)

29. WOMENS HEALTH • WOMENS HEALTH • PLEASE ENTER CBW AS THE CODE FOR THIS INSURANCE. • IF PATIENT HAS ANOTHER INSURANCE, IT WILL BE LISTED AS PRIMARY. • THESE CARDS ARE ONLY GOOD FOR ONE YEAR, THEREFORE WATCH THE DATES CLOSELY!

30. NEW INSURANCE • If patient has new insurance information, try to find out when it became effective and give this information to the insurance clerk. • Post a note into the account by using the Note Entry option on the top toolbar.

31. WORK COMP

32. WORK COMP • VERIFY WITH THE EMPLOYER • Never assume something is work comp! • Obtain the injury date from the employer and make sure it is consistent with what the patient is telling you. • If the claim is a workcomp there should always be an accident date and remember some claims can be open for a very long time!

33. PATERNITY TEST • Call the laboratory WHILE registering the patient to determine whom the bill needs to go to. • Once a test is sent out, we have no way to know where to send the bill without this information! The lab will NOT keep a copy of this!!!

34. STILL UNSURE... Call and ask if you do not know what to do. The sooner we can fix a problem the better!

35. Some cards are tricky Paul Mueller Company Greater Regional Medical Center - Principal

36. Some cards are tricky Graceland University - Principal Summit America

37. Some cards are tricky Golden Rule Direct Med

38. Some cards are tricky Assurant Health

39. Some cards are tricky Midlands Choice Medco

40. Some cards are tricky CIGNA United Healthcare of the River Valley

41. Some cards are tricky CIGNA Midlands Choice

42. Some cards are tricky Interplan Health Group Midlands Choice – American Administrators

43. Some cards are tricky Golden Rule

44. Some cards are tricky BUT……. Make sure to check the payer ID on the card to see if it matches the insurance code you have selected. This is a great way to verify if you have chosen correctly.

45. STILL UNSURE... Call and ask if you do not know what to do. The sooner we can fix a problem the better!

46. Call 3268 for assistance with insurance questions.

47. Time is money! The better we are at understanding insurance during registration, the better our AR days will be!