/depts/,/depts/uwmf/,/depts/uwmf/patient-business-services/,/depts/uwmf/patient-business-services/eligibility-feeds/,

/depts/uwmf/patient-business-services/eligibility-feeds/

201407196

page

100

UWHC,UWMF,

Departments & Programs,UW Medical Foundation,Patient Business Services

Eligibility Feeds

Eligibility Feeds - Departments & Programs, UW Medical Foundation, Patient Business Services

Focus

Registration Tips and Scenarios (PPIC, GHC, GHC of Eau Claire and Unity patients)

Scenario One: Patient presents and states that Unity, PPIC, or GHC coverage has terminated, but our system is showing it has not terminated.

Scenario Two: Patient presents and states that Unity, PPIC, or GHC coverage is effective, but our system is not showing it.

General Comments

Following these comments will help prevent duplicate coverages, retroadjudication, claim rejections and upset patients.

Relationship to Subscriber Field - In the Relationship to Subscriber field

 If Unity system reads: Then enter into Epic:
 00 (self)  01 (self)
 01 (usually spouse, but not
always)
 02
 02-99 (dependent)  16 (sponsored dependent)
 If PPIC (Amysis) system reads: Then enter into Epic:
 01 (self)  01 (self)
 02 (usually spouse, but not
always)
 02
 03-99 (dependent)  16 (sponsored dependent)

We had to choose “generic” dependent codes for this field because most carriers don’t give us what the dependents true relationship to the subscriber is (Spouse, Foster Child, Grandchild, Natural Child, etc.), only that they are a dependent. It is very important to use the correct code in this field, because if the information is not correct, eligibility may ignore the manually loaded coverage and load another coverage.