Overview of Insurance Plans and Medicare

Types of Insurance Plans

• Medical plans include Medicare, United Healthcare, and Anthem Blue Cross.
• Discount or business policies include BFC, Superior Vision, iMed, and BBA.

Where to Find Insurance Information

• Local coverage details are available on specific policy websites.
• Clearinghouses like GatewayEDI and Apex can provide patient eligibility and claims.
• Medicare has a dedicated website with state-specific links managed by Medicare Administrative Contractors (MACs).

Medicare Information

• California uses the Nidian Medicare site; Medicaid varies by state.
• Federal employee plans commonly have Blue Cross and Blue Shield coverage.
• The CMS website offers access to coverage forms, PQS information, and fee schedules.

Medicare Learning Network (MLN)

• MLN provides video resources, PowerPoints, and educational documents for providers.
• Coverage details can vary based on the provider's MAC location.

Updating Medicare Information

• Contracting information with Medicare must be current; changes need to be reported within 30 days.
• Contact details, business types, and other changes can be updated online via the Provider Enrollment, Chain, and Ownership System (PECOS).

Durable Medical Equipment (DME) Contractors

• DME suppliers are categorized by geographical regions; examples include Meridian and Signant.
• Maintain accurate records for DME products dispensed, including prescriptions and patient details.

NPI Registry

• Providers must keep their NPI registry updated, including applying for new NPI numbers if needed.
• Search for NPI numbers of other providers through the NPI registry site.

Commonly Used Payer Websites

• Key sites include unitedhealthcareonline.com, Aetna, Signa, and Humana.
• Add frequently used payer sites to favorites for easy access.

Taxonomy and Remittance Advice Codes

• Taxonomy codes are specific to each specialty, e.g., Optometry is 152W00000X.
• The WPCD.com website can be used to look up taxonomy codes and claims adjustment codes for better claims management.

Types of Insurance Plans

• Medical plans encompass Medicare, United Healthcare, and Anthem Blue Cross.
• Discount and business insurance policies include BFC, Superior Vision, iMed, and BBA.

Where to Find Insurance Information

• Local coverage information can be accessed on specific insurance policy websites.
• Patient eligibility and claims can be clarified through clearinghouses like GatewayEDI and Apex.
• Medicare offers a dedicated website featuring state-specific links managed by Medicare Administrative Contractors (MACs).

Medicare Information

• California utilizes the Nidian Medicare site, while Medicaid varies by state requirements.
• Federal employee plans frequently include coverage from Blue Cross and Blue Shield.
• The CMS website provides access to various coverage forms, PQS information, and fee schedules.

Medicare Learning Network (MLN)

• MLN offers various educational resources, including videos, PowerPoints, and documents for healthcare providers.
• Coverage details can differ based on the location of the provider’s MAC.

Updating Medicare Information

• Providers must keep Medicare contracting information current and report changes within a 30-day period.
• Updates to contact details, business types, and other relevant information can be conducted online via the PECOS system.

Durable Medical Equipment (DME) Contractors

• DME suppliers are classified by geographical regions; examples include Meridian and Signant.
• It is essential to maintain precise records for dispensed DME products, including patient prescriptions and details.

NPI Registry

• Providers must regularly update their NPI registry and apply for new NPI numbers as necessary.
• NPI numbers of other providers can be found using the NPI registry website.

Commonly Used Payer Websites

• Important payer websites consist of unitedhealthcareonline.com, Aetna, Signa, and Humana.
• Frequently used payer sites should be added to favorites for convenient access.

Taxonomy and Remittance Advice Codes

• Taxonomy codes are unique to each specialty; for example, Optometry corresponds to code 152W00000X.
• The WPCD.com website can be utilized to look up taxonomy codes and claims adjustment codes for improved claims management.

This quiz covers various types of insurance plans, including Medicare and other medical policies. It discusses where to find insurance information, details on Medicare coverage, and available learning resources. Ideal for those looking to understand the intricacies of healthcare coverage options.