Phunzirani za Zomwe Zamalonda Zokhudza Zamankhwala
Malangizo a Kuthandizira (RA) ndi chikalata chomwe amapereka ndi inshuwalansi yomwe imapereka chidziwitso ndi kufotokoza zifukwa za kulipira, kusintha, kukana ndi / kapena kufotokoza milandu ya madokotala. Kaŵirikaŵiri zimapereka malipiro a Medicare ndi Medicaid . Kawirikawiri amatchulidwa ngati kufotokoza kwa kulipira (EOB) ndi ena omwe amapereka inshuwalansi.
Mitundu Yopereka Zowonjezera
- Malangizo Otsitsirako Zamakono (ERA): RA yomwe imafalikira pamagetsi
- Malangizo Othandizira Otsatira (SRA): RA yomwe imatumizidwa mu mapepala
Ambiri a inshuwalansi athandiza kugwiritsa ntchito ERA. Zopindulitsa zimaphatikizapo luso lolemba malipirowo mwamsanga ndipo mwamsanga kuzindikira kutaya kumene kupangidwa panthawi yamalipiro oyambirira kupanga zofunikira zoyenera.
ANSI 835 ndizolembera zamagetsi komanso zothandizira anthu kuti athandizidwe. Malamulo a HIPAA amafunika kugwiritsa ntchito 835 monga malamulo oti m'malo mwa EOB apezeke pamene odwala atalandira ndalama zamagetsi.
Zomwe Zikuphatikizidwa pa Malangizo Akutumizira
Malangizo othandizira kubwezera ayenera kuphatikizapo zina kapena zonsezi:
- Malipiro Olipira: Ndalama ya dola yomwe imalipidwa ndi wobweza
- Ndalama Zovomerezeka: Ndalama yovomerezeka ikufanana ndi ndalama zonse zomwe zakhala zikuvomerezedwa ndi wobweza
- Chilolezo Chololedwa: chilolezo chololedwa chikufanana ndi ndalama pa chiwerengero chonse chomwe chinaloledwa ndi wobweza
- Udindo wodwala Mtengo: ndalama zomwe ndizofunika kwa wodwalayo zomwe zimayimira wodwala copay, ndalama zothandizira ndalama , ndi ndalama zokwanira
- Ndalama Zowonongeka: Ndalama yowonongeka ili yofanana ndi chiwerengero cha chiwerengero cha chiwerengero chomwe chimaperekedwa ndi wobwezera
- Ndalama Zowonjezera: mtengo wa dola wa kuchotsera malipiro oyamba kapena kukonzanso mgwirizano
- Tsiku lachigamulo: tsiku limene chigamulocho chinapatsidwa chigamulo ndi / kapena kulipira
Malangizo omwe angatulutse angasonyezenso olemba malipiro oyendetsa mkati (ICN), fufuzani nambala, mautumiki apadera, kufotokozera zamagwiridwe, kutsutsa zifukwa zoganizira, ndikufotokozerani zifukwa.
Malangizo Otsitsirako Zamakono (ERA)
Kugwiritsa ntchito njira zamakono zothandizira (ERA) ndi njira yofulumira komanso yolondola kuti mutumize malipiro anu komanso kusintha ndi kukana. ERA, komabe siigwira ntchito popanda kugwiritsa ntchito ndalama zamagetsi (EFT). EFT idzatsimikizira kuti malipiro anu adzatumiza mwachindunji ku akaunti yanu ya banki kusonyeza ERA yanu. Mukhoza kulembetsa mapinduwa mwachindunji kapena kudzera mu nyumba yosungirako zinthu. Ndondomekoyi idzagwira ntchito mofanana ndi njira yogula ndalama.
Chitsanzo: Malangizo Othandizira Kutumizira
Malangizo othandizira kupereka chithandizochi amasonyeza mfundo zofunikira, maina a gulu ndi zina zomwe zingapangidwe zingakhale zosiyana malinga ndi omwe amapereka inshuwalansi.
ABC INSURANCE COMPANY
DZINA LA PATIATI: JOHN DOE
PATIENT ACCT: 123123123
MEMBER ID NO: 554554554
PAYER ICN NO: 123456789XYZ
DATE LA SVC: 01/01/2012
KUKHALA MALAYEDWE: 01/15/2012
ZOCHITA ZA UTUMIKI
ZINTHU ZONSE: $ 100.00
KULEMBEDWA KWAMBIRI: $ 80.00
PATSAMBA AMOUNT: $ 20.00
COPAY: $ 20.00
NKHONDO: $ 8.00 (10%)
KUYANKHA KWA PATIENT: $ 28.00
KUDZIWA KWAMBIRI: $ 52.00
ZIZINDIKIRO
ZOPEREKA ZIMAPEREKEDWA NDI MALANGIZO
Mawu ena okhudzana ndi Kuthandizira Malangizo ndi awa:
- Nambala ya Akaunti: nambala imene wapatsidwa kwa wodwala aliyense amayendera kuti awone milandu ndi malipiro opangidwa tsiku linalake.
- Coinsurance: amasonyeza momwe munthu wothandizira inshuwalansi ndi bedi amagawaniza mtengo wa madola a zachipatala mutatha kuchotsedwa. Pomwe ndalama zowonjezera zakhala zikufikira, inshuwalansiyo idzatenga udindo wa 100 peresenti ya ndalama zina zowonjezera.
- Kukhomeredwa: Ndalama ya ndalama yomwe amaikidwa ndi inshuwalansi yaumoyo wodwalayo kuti azilipiritsa ntchito yowonjezera, kawirikawiri ndiyomweyi.
- Deductible : ndi gawo lazinthu zomwe sizinapangidwe ndi inshuwalansi ndipo zimayenera kulipidwa ndi inshuransiyo musanapindulepo ndi ndondomekoyi.