Work Codes and names

• 485
• r1369

• Hi this is Jessica with southeast eye specialist I would like
• - a routine split for E and G codes
• - what is the co pay
• or
• - a medical auth ok
• - ask for a reference number for the call
• Get person's name

insurance verification, select location, lightning bolt, select dates on calendar and print, once printed go to template, select date, select doctor (under proceed) select location, select patient, click custom field and change to yes

• If patient is not eligible, policy termed
• any information incorrect (DOB, name)
• if auto insurance is listed

• write date of visit, location, Panacea ID#
• check insurance codes
• check receivables for glasses
• add additional medicare info--2 checks if met 1 check and ded left if not

• 321 Eyefinity (login is store specific)
• authorization to check eligibility, member search, put in SSN, select patient 2 times, check exam, authorize, print 1 pg, click back to chck frame and lense & print 2nd report for mat)
• fax to location

• 12
• If it says Advantica or Comp Benefits (830# look up with dob and ssn then call primary plus) check AHCA
• mcd # short with X use card control
• check for other HMO
• Adult 21up glasses every 2 yrs/ under 21glasses every yr always check recievables to make sure valid QMB doesn't cover glasses

1625 Advantica (check eligibility, input pt id#, check to see if green, correct name and dob, view utilization and print)

• 11
• Zir Med (eligibility, n inquiry, medicare A B, put in id, last name, and dob)
• If both Medicaid and Medicare list Medicare first in note but look up Medicaid first and in Medicare check part B give one check for active and two in ded is met ($0)
• Check for other HMO

• 541
• Comp Benefits/ Humana
• ID # begins with several 000
• make sure full allowance is there
• fax to location

• 7 or 161 (state employee starting XJJH)
• Availity
• After input info/ look under health benefit plan
• On report list ded amount and what has been met //select out of network check profess visit to get % of copay
• BCBS & VCP check both
• -active-medical copay-cover 2 exams per yr
• XJBH no rt exam

• AHAC
• 1391
• begins with 790 look up by ssn
• call primary plus to get E/G code or medical ok auth

• UHC 224
• double check in Spectera

141

• 1426 no medical
• check in Medicaid if comes up UHC

• Premier call
• 1626
• Stay well PT ID begins with 400
• Well care Medicaid= Health Ease

• Premier- call
• 127
• Well Care Medicare= Well Care

• fax to location
• 9

• fax to location
• 638

• Look up in Medicaid
• if ID begins with 686 look up in Advantica
• if begins with mm Advantica

follow Medicaid guidelines if elig

• look up in UHC and then Spectera
• always out of network benefits for medical copay
• check additional benefits (physician services)

• exam
• exam and mat
• mat only   (mat can be glasses or cl
• medical issue
• follow up for medical (only need to check if in another month)
• follow up cl- no need to verify

• insurance active?
• what is ded and have they met it
• what is the co pay
• look up alternative plans
• other special info
• if medical or IOP don't look up for rt exm

call if Conventry, Vista, or Comp Benefits

591617237

1790845337

• 161
• 17 or older 1 exam per yr/ younger than 17 exam every 2 yr
• if has medicare and BCBS when medicare ded not met pt subject to pay $25 co pay, then BCBS pay Medicare balance