Insurance Scheduling and Guide

Practice flashcards covering insurance provider scheduling protocols, plan codes, and eligibility requirements based on the lecture notes.

UHC Dual Complete

A plan scheduled as New Tenncare that requires an insurance referral authorization from the patient's Primary Care Physician (PCP).

Ascension Insurance Plans

Plans not accepted in Clarksville because their insurance requires work to be done at their own hospitals, of which there are none in the Clarksville area.

BCBS Net L (Smart Health)

A plan where coverage is tied to the employer requiring work to be done at their specific hospital. NOT ACCEPTED IN CLARKSVILLE.

Wellpoint Tenncare (Regular)

A plan scheduled as New Tenncare.

Wellpoint Medicare Advantage

Previously known as Amerivantage, this plan always includes a "W" and is scheduled as New/Return.

Bluecare Plus

A combination of Bluecare and Medicare using codes $ZEUY$ or $ZEYY$, scheduled as Medicare or GOVT New return patient.

Bluecare Cover Kids

Designated by code $ZECM$, these are scheduled as TennCare (approval only) and only cover the children, not the parents.

Regular Bluecare

A plan the facility does not participate in; patients may only be seen by certain doctors with specific approval.

Medicare Eligibility

Requirements include being $65+$ years of age or having Social Security disability benefits to qualify.

Medicare Advantage Plan Replacement

Booked as GOVT, these plans cover extra costs and typically combine Medicare and supplemental insurance on one card.

UHC Community Plan

A plan booked as New Tenncare with no payments, where everyone in the household is covered by Tenncare.

Authorizations

Specific permissions from insurance that are defined as being body part specific.

BCBS Bluecare Codes

Tenncare plans identified by the codes $ZECM$ or $ZEDM$ and booked as New Tenncare.

Bluecare+ Codes

Plan codes $ZEUY$ or $ZEYY$ representing both Medicare and Medicaid, booked as New return patient GOVT.

BCBS of TN Networks

Networks S, P, and E, which are scheduled as New return patient.

BCBS Medicare Advantage Code

Plan identified by code $ZXDY$ and scheduled as New return patient GOVT.

BCBS Bluecard

Out of state Blue Cross Blue Shield plans such as Anthem, Highmark, or Premara, scheduled as New return patient.

Blue Cross Blue Shield Federal

Plans for federal employees identified by a Group Number is usually $103$ numbers or the letter "R", scheduled as New return patient.

Champ Va

A plan that needs approval for all services and is booked as New/Return GOVT.