Here are the most common types of managed care plans. It is important to know them because each insurance plan has specific billing and coding methods.
EPO: Exclusive provider Organization.
HMO: Health Maintenance Organization.
IPA: Independent Practice Association.
POS: Point Of Service.
PPO: Preferred Provider Organization.
Managed Care Plan Co-pay/Deductible Payment Authorization Required HMO […]
Eligibility consists of an on-the-job injury or a condition that is a direct result of the individual’s job. The law states that a waiting period must elapse before benefits are payable. This period is different from state to another. Classifications […]
This notice must be completed, signed, and dated, also the modifier GA must be used when sending the […]
The following table explains Medicare covered and non-covered services in Medicare Part B.
Medicare Secondary Payor
In some cases there is a primary insurance that should pay before billing Medicare. In these cases, Medicare is the secondary insurance and another company is the primary insurance. […]
CMS 1500 is the form used to submit claims.
Deductibles are often $100 for physician services and outpatients.
Allowable amount will vary according to the plan, but we usually see the allowable amount 80%.
A surgical financial disclosure form is required for all […]
Tricare differs from other insurance companies. Tricare is a health care program for:
Eligible survivors of members of the uniformed services. Active duty members of the military and qualified family members. Champus eligible retirees and qualified family members.
Tricare consists of three main plans:
Tricare’s fiscal year for collecting deductible runs […]
Aetna is one of the most important insurance carriers in the United States and generally, billing an insurance company is different from one to another. In this post I got some of the medical office codes that Aetna covers for PCP (Prime Care Physician.)
Hi coders, today we have frequently repeated medical billing terms that we read in insurance policies, EOBs and sometimes face sheets. It is important to know well these terms to do your billing correctly and accurately.
Under the jurisdiction of the Department of Health and […]
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