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Insurance UPDATES

Insurance UPDATES

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Insurance UPDATES

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  1. Insurance UPDATES February 2012

  2. New Electronic Form 4010 vs. 5010 4010-Old version 5010-New Version as of January 1,2012 • 4010: The person reported as the "subscriber" was always the person who held the insurance policy.  A dependent of the subscriber was reported as the "patient".

  3. 5010 format • 5010: The person reported as the "subscriber" or "patient" is determined by how the payer assigns the member identifier.  If the payer assigns a single member identifier for the subscriber and dependents, then the "subscriber" is the policy holder and the dependent is reported as the "patient".  • If the payer assigns unique member identifiers to each member of the family( 01,02,03,04 etc), then each person/patient is reported as the "subscriber".

  4. What this change means • If the payer assigns unique member identifiers to each member of the family, then each person will be reported as the “Subscriber” with their unique member identifier on all claims. • This change is consistent with the eligibility request and response transactions. • If the payer assigns one member identifier for an entire family, then there will be no change to how you currently report the “Subscriber”.

  5. EXAMPLES • Sasha is our patient. She has a unique identifier -05 so she is the subscriber, not her father Ralph who is the policy holder.

  6. EXAMPLES

  7. Examples • Aspen is our patient. She has a unique identifier -04 so she is the subscriber, not her father who is the policy holder.

  8. examples

  9. example • Logan is our patient. There is NOT an unique patient identifier. Brian Kugler his father and is the policy holder; therefore the subscriber would be Brian.

  10. example

  11. Examples • John is our patient. Elisabeth the policy holder…is there a unique member identifier? Who is the subscriber?

  12. examples • Shirley is our patient. Bruce is the policy holder. • Is there a unique member identifier? Who is the subscriber?

  13. Other Insurance Updates • BCBS has issued new insurance cards for 2012.  We are seeing that they are changing the patients ID number. • MVP is also issuing new cards for 2012 and we are seeing that they are changing the prefix letter "A" to the number "8".

  14. Other Insurance Updates • When you update patient insurance in Allscripts, please remember to EXPIRE the current insurance and add a new insurance for the new ID number, even if the address to submit claims is the same as the "old" insurance.

  15. Other Insurance Updates • The reasoning behind setting a new insurance vs. just "editing" the ID number— • The billers are still working on Claims that were billed out with the old ID number.  If we edit the ID number, all claims attached to it will change to the new ID number, causing issues when rebilling to the insurance company.  • The denials they have been getting have been due to the subscribers ID number being invalid.  By keeping the old expired insurance separate from the new insurance, we will limit confusion as to which ID number goes with which claim.

  16. Other Updates-Denied Claims

  17. Other Updates-Denied Claims

  18. Questions?