Responsible Party (Guarantor)
The person who says he or she will pay any money due to the health care provider that is not paid by the insurance company
The person seeking health care treatment or service
The person who gets the insurance policy, either directly or through work
Primary Insurance policy
The contract that names the patient as the policyholder, or insured party
Rule used to establish the primary insurance policy for a child by setermining which parent has a birthday closer to January 1st
ID number (policy number)
The numbr or sometimes a combination of letters and numbers that connects an individual to a specific insurance policy
Group name or number
A number or combination of letters & numbers that connects an individual policy with a specfic group of insureds
Referring Physican (referring provider)
The health care professional who recommened this individual see this specailist or another health care provider
The Policyholder gives permission to the insurer to pay the benefits directly to the provider. When Medicare is the insurer, this also means that the provider agrees to accept the allowed amount from Medicare as payment in full
Calling the insurance carrier to confrim the patient has an active policy
Confriming that the health issue to be addressed at this visit or the specfic procedure will be covered by the patient's plan
A form upon which a face-to-face visit between provider and patienrt is documented
An encounter form that is preprinted with the diagnosis (ICD-9-CM) codes, as well as the procedure (CPT) codes, most frequently used in that office. Also known as a routing slip or free ticket
The written or dicated notations of an encounter between a provider and an individual. Also known as medical notes or provider's notes.
Patient Reistration Form
Doesn't contain PHI; specifies responsible party and pollicyholder;
types of documents involved in the pt. care process
Patient registration form, superbill/encounter form, physcians notes, progress notes
With adults that have there own policy and are named as a dependent on another insurance; which policy is their primay or secondary?
The insurance policy that names the patient as a policyholder NOT as a dependent
The parent who has a birthday closest to January 1st is the primary insurance for the child this can also be the same for a spouse
What can over rule the birthday rule?
Custody and court
What do you information do you need to get from the insurance card?
Customer service number #, ID number or policy #, Group #, Co-pay, Co-insurance & Admission certification
How do you make certain that you have all this information from the insurance card?
Copy both sides