copyright © 2008 delmar learning. all rights reserved. chapter 12 commercial insurance
TRANSCRIPT
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Copyright © 2008 Delmar Learning. All rights reserved.
Chapter 12
Commercial Insurance
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Copyright © 2008 Delmar Learning. All rights reserved.
2
Introduction
• This chapter is going to be talking about how to complete fee-for-service claims
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Copyright © 2008 Delmar Learning. All rights reserved.
3
Processing Commercial Claims
• Separate instructions for primary, secondary, and supplemental commercial insurance plans.
• Instructions in a table format for completing claims.
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4
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
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5
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
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6
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
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7
Commercial Secondary Coverage
• Changes are made to the CMS-1500 claim when patients are covered by primary and secondary or supplemental health insurance plans.