Zifukwa 10 Zowonjezera Zowonjezera Zimakanidwa

Kumvetsetsa zifukwa zomwe madokotala akutsutsira kuti akutsutsa ndi a inshuwalansi akhoza kuthandizira kuchepetsa chiwerengero cha kukanidwa kumene ofesi yanu yachipatala imalandira. Njira yokhayo yowatetezera ndiyo kuzindikira zomwe iwo ali.

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Chodziwika Chodziwitsa Odwala Wachidziwitso

Ndikofunika kutumiza chidziwitso chachipatala ndi chidziwitso chodziwika bwino cha odwala. Popanda kudziŵa zambiri, ndondomeko ya inshuwalansi yathanzi siingathe kudziwa kuti wodwalayo apereka malipiro kapena kugwiritsa ntchito chidziwitso cha zomwe akufunira chikugwiritsidwa ntchito ku akaunti yothandizira inshuwalansi ya thanzi.

Zina mwa zolakwika zomwe zimachititsa kuti chigamulo chikanike chifukwa chachinsinsi chodziwitsa odwala ndi:

• Dzina la olembetsa kapena wodwalayo lalembedwa molakwika
• Tsiku la kubadwa kwa wodwala kapena wodwalayo pazomwe akutsutsa sikugwirizana ndi tsiku la kubadwa mu dongosolo la inshuwalansi ya umoyo
• Nambala ya olembetsa ikusowa kuzinena kapena zosayenera
• Nambala ya gulu la olembetsa ikusowa kapena ilibe

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Zolemba Zatha

Kutsimikizira ubwino wa inshuwalansi musanatumikire maulendo angathe kuchenjeza ofesi yachipatala ngati wodwalayo akuwombera inshuwalansiyo kapena akutha. Izi zidzakuthandizani kuti mudziwe zambiri zokhudza inshuwalansi kapena kudziwa wodwala ngati kudzipangira nokha.

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Amafuna Kutsegulidwa Koyambirira kapena Precertification

Mapulogalamu ambiri omwe amalingaliridwa ngati osagwirizana ndi zochitika zadzidzidzi angafune chilolezo. Ndizozoloŵera kwa ambiri omwe amapereka inshuwalansi kuti apeze chilolezo chotsatira chithandizo cha radiology chokwanira monga ultrasound, CT, ndi MRI. Njira zina zochizira opaleshoni komanso odwala matenda odwala matenda opatsirana angalandire chilolezo.

Mapulogalamu omwe amaperekedwa kwa wodwala amene amafuna chilolezo chisanayambe adzakanidwa ndi wothandizira inshuwalansi. Mapulogalamu sangakanidwe ngati mautumiki operekedwa akuonedwa kuti ndi achipatala. Wopereka akhoza kuyesa kupeza chilolezo cha retro mkati mwa maola 24 mpaka 72 mutatha kulandira thandizo malingana ndi malangizo a opa inshuwalansi.

Zambiri

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Mapulogalamu Osaphatikizidwa kapena Osaphimbidwa

Zomwe simukuzidziwa kapena zina zomwe simukuzigwirazo zimapereka thandizo kwa maofesi ena a ofesi ya zachipatala omwe amachotsedwa ku inshuwalansi ya umoyo wa wodwalayo. Odwala ayenera kulipira 100 peresenti pazinthu izi.

Ichi ndi chifukwa china chomwe nkofunikira kulankhulana ndi inshuwaransi ya wodwala musanayambe utumiki. Ndi ntchito yoperewera kwa makasitomala kuti azilipiritsa wodwalayo chifukwa cha zolakwa zomwe sizinapangidwe popanda kuwadziwitsa kuti angakhale ndi mlandu pa milanduyo asanayambe.

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Pempho la zolembedwa zamankhwala

Mapulani ena a inshuwalansi a zaumoyo angafunse zolemba zachipatala pamene chilolezo chimafuna zolemba zina kuti chigwiritse ntchito chigamulochi. Zolemba zachipatala zimaphatikizapo koma osati zochepa pa zotsatirazi:

• Mbiri yachipatala yoleza mtima
• Nkhani zoleza mtima
• Malipoti owonetsera zachipatala
• Zokwanira zochotsera odwala
• Malipoti a Radiology
• Mauthenga ogwira ntchito

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Kugwirizana kwa Mapindu

Kukonzekera kwa kukanidwa kopindulitsa kungaphatikizepo:

• Other inshuwalansi ndizofunikira
• EOB yoperewera ( kulingalira kwa phindu )
• Mamembala sadasinthidwe insurer ndi ma inshuwalansi ena

Kugwirizana kwa phindu ndilo limagwiritsidwa ntchito pamene wodwala ali ndi mapulani awiri a inshuwalansi. Malamulo ena amagwiritsidwa ntchito pofuna kudziwa kuti ndondomeko ya inshuwalansi ya umoyo imalipilira pulayimale, yachiwiri kapena maphunziro apamwamba. Pali zifukwa zingapo kuti mudziwe kuti ofesi ya zachipatala imayenera kulipira ndondomeko yanji ya inshuwalansi.

Zambiri

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Bill Liability Carrier

Ngati chidziwitsocho chalembedwa ngati ngozi ya auto-kapena yokhudza ntchito, othandizira ena amakana kulipira mpaka galimoto ya inshuwalansi kapena wobwereketsa wogwira ntchito akulipidwa.

Pazinthu zokhudzana ndi ngozi, inshuwalansi yowonjezera yachitatu iyenera kuikidwa ngati yoyamba:

1. Magalimoto kapena Inshuwalansi ya Auto Auto kuphatikizapo palibe vuto, ndondomeko kapena Med Pay
2. Inshuwalansi Yothandizira Ogwira Ntchito
3. Inshuwalansi ya mwini nyumba
4. Malonda a Inshuwalansi
5. Inshuwalansi Yopindulitsa Amalonda

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Ma Code Osowa kapena Osavomerezeka a CPT kapena HCPCS

Kuti madandaulo azachipatala agwiritse ntchito molondola, pali zizindikiro zomwe zimagwiritsidwa ntchito pozindikira ntchito ndi njira. Ndondomekoyi yamakono imatchedwa Healthcare Common Procedure Coding System (HCPCS ndipo imatchedwa "zisamaliro zosankha.")

Onetsetsani kuti zizindikiro zanu zachipatala zimakhalabe zatsopano pa code HCPCS. Kusintha kwa ma code HCPCS kumasinthidwa nthawi ndi nthawi chifukwa cha zizindikiro zatsopano zomwe zapangidwira njira zatsopano ndi zizindikiro zamakono zikukonzedwa kapena kutayidwa.

Zambiri

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Kusindikiza Kwadongosolo

Dziwani nthawi yopezera nthawi yothandizira aliyense wa inshuwalansi. Zitsanzo zina za nthawi yotsatsa nthawi yake ndi izi:

• United Health Care: Miyeso yolemba nthawi yake imatchulidwa mu mgwirizano wothandizira
• Cigna: Pokhapokha ngati lamulo ladziko kapena zochitika zina zikugwira ntchito -
  1. Ogwira nawo ntchito zaumoyo ali ndi miyezi itatu (3) (masiku 90) pambuyo pa tsiku la utumiki.
  2. Omwe amatulutsira pa intaneti ali ndi miyezi isanu ndi umodzi (masiku asanu ndi limodzi) (masiku 180) pambuyo pa tsiku la msonkhano.
• Aetna: Pokhapokha ngati malamulo a boma kapena ntchito ina ikugwira ntchito -
  1. Madokotala ali ndi masiku 90 kuchokera tsiku la utumiki kuti apereke chilango cholipira.
  2. Mzipatala zili ndi chaka chimodzi kuchokera pa tsiku la utumiki kuti lipereke chilango cholipira.
• TRICARE: Zofunikirako ziyenera kutumizidwa mkati mwa chaka chimodzi pambuyo pa tsiku la msonkhano.

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Palibe Kulembera pa Fayilo

Njira zina zimafuna kuti wodwala apemphere kuchokera kwa dokotala wawo wa banja asanayambe kumasulidwa.