Archive for the ‘Billing’ Category

Harvard Pilgrim or Health Plans, Inc?

Tuesday, March 11th, 2008

It’s often confusing when trying to identify if a patient is covered through Harvard Pilgrim or Health Plans, Inc. by looking at their card. Both insurance cards show the Harvard Pilgrim name and logo, usually in the upper left corner. At a quick glance, one might be tempted to merely list Harvard Pilgrim in the system and call it good. However, Health Plans, Inc. cards also have their name on the upper right. When claims are sent to the wrong insurance company ,they are denied and returned to the healthcare facility for correct billing.

Besides looking for the Health Plans, Inc. brand on the upper right corner of the card, here is the easiest way to distinguish one plan from the other:

If the insurance ID begins with HP, it’s Harvard Pilgrim.

If the insurance ID begins with HH, it’s Health Plans, Inc.

It’s as simple as that. Get this one distinction in your memory and never have your Harvard Pilgrim/Health Plans, Inc claims bounced back again.

Mitigating Medicare Mishaps

Tuesday, March 4th, 2008

Medicare numbers, also called Health Insurance Claim (HIC) numbers, are almost always 9 digits with a letter suffix, such as 000-00-0000A. The HIC is the wage earner’s Social Security Number (SSN), which could be either the patient’s, a spouse’s or a parent’s SSN. Because of this, you can’t assume that the patient’s Medicare number is always their SSN+A. It is important that you have them read the number to you from their card if updating the patient on the phone, or that you see the card if you have the patient in front of you.

In some instances, HIC numbers can change, though usually it is only the ending letter. For example, a patient receiving spousal benefits (spouse’s SSN + B) will have their Medicare number change to a survivor’s benefit (spouse’s SSN + D) when the spouse expires. For this reason, you should always update a patient’s Medicare number as you would any other insurance when registering. This is also a good time to make sure the patient does not have a Medicare Replacement/Advantage Plan.

In some computer systems, when entering a HIC number it is important make sure there are no leading spaces. If there is a number following the suffix, such as B2, a leading space will keep the number 2 from transferring to billing software. This may delays claim processing and create more work for billers. For this reason, it is also a good practice not to have leading spaces in any insurance ID.

More Medicare Trivia (or Muddling Through the Medicare Miasma)

Railroad Retiree Medicare numbers have a letter prefix, such as MA000-00-0000.

Typical Medicare HIC Suffixes include the following:
A —patient’s SSN (wage earner)
B —spouse of wage (also B1 through B9!)
C —child (could be followed by a number or letter)
D —widow (could be followed by a number or letter)
E —mother/widow (could be followed by a number or letter)
F– F1 Father, F2 Mother, F3 Stepfather, F4 Stepmother, F5 Adopting father, F6 Adopting mother, F7 Second alleged father, F8 Second alleged mother
K —receiving wife’s special age 72 benefits through her husband (could be followed by a number or letter)
J1 —receiving special age 72 benefits (also J2, J3, and J4)
M —has enrolled in Part B ONLY, but receives no monthly Social Security benefits (also M1)
T —has enrolled in Part A and possibly Part B, but receives no monthly Social Security benefits (could be followed by a number or letter)
W —disabled widow/widower (could be followed by a number or letter)

Correctly Identify Insurance

Monday, March 3rd, 2008

At the hospital/office, we’re only as up to date and informed as the information given to us. If we’re not given any information, however, then it stands to reason that we’re not informed or up to date. If we’re not given any information because we can’t squeeze blood from a rock, that’s one thing. If we’re not given any information because we aren’t asking for it, then shame on us.

It is vitally important that we are viewing insurance cards when we do account updates. It’s important that we ask the patient to get their insurance card and read us the numbers when updating an account over the phone. My favorite errors are where the account comments read “no insurance changes per pt” or “per mom”. And then guess what? The patient’s Medicare ID isn’t their SSN with an A after it. They now have a Medicare Advantage Plan instead of classic Medicare. Or, their business changed from Aetna PPO to Aetna HMO, but we only asked if they still had Aetna.

It’s concerning when the account information states that the patient was just completely updated, yet the Anthem website says we have the wrong insurance prefix or the wrong review group, address, subscriber, etc.

If we are sure to stress that we need to see the card instead of asking “have there been any changes,” then we are less likely to have incorrect billing information. When you have correct billing information, you are saving your business money. When you have correct billing information, you are performing very good service to your patients because they don’t receive bills for services that should have been paid for by their insurance. When you collect correct billing information, we all win.