Chapter 12 Commercial Insurance Copyright 2008 Delmar Learning

  • Slides: 7
Download presentation
Chapter 12 Commercial Insurance Copyright © 2008 Delmar Learning. All rights reserved.

Chapter 12 Commercial Insurance Copyright © 2008 Delmar Learning. All rights reserved.

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

Introduction • This chapter is going to be talking about how to complete fee-for-service claims 2 Copyright © 2008 Delmar Learning. All rights reserved.

Processing Commercial Claims • Separate instructions for primary, secondary, and supplemental commercial insurance plans.

Processing Commercial Claims • Separate instructions for primary, secondary, and supplemental commercial insurance plans. • Instructions in a table format for completing claims. 3 Copyright © 2008 Delmar Learning. All rights reserved.

Processing Commercial Claims • A case study and completed claim to illustrate the instructions

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 4 Copyright © 2008 Delmar Learning. All rights reserved.

Commercial Claims • Determined by one of the following criteria: – Patient is covered

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 5 Copyright © 2008 Delmar Learning. All rights reserved.

Commercial Claims • Determined by one of the following criteria: – When the patient

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 6 Copyright © 2008 Delmar Learning. All rights reserved.

Commercial Secondary Coverage • Changes are made to the CMS-1500 claim when patients are

Commercial Secondary Coverage • Changes are made to the CMS-1500 claim when patients are covered by primary and secondary or supplemental health insurance plans. 7 Copyright © 2008 Delmar Learning. All rights reserved.