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adjusted claim claim where the amount paid has been corrected
balance billing when provider attempts to bill patient the write off
community spouse spouse that lives at home while other is in nursing home suffering
dual eligible receives benefits from medicare and medicaid
mother baby claim used for babys first ten days of life while babys medicaid application is being processed
payer of last resort medicaid is paid last, after every other insurace company, bacuse medicaid had like mo money, at all
presumptive eligibilty allows individuals to be enrolled in medicaid for limited time before full application is filed and processed
QMB resources at below twice SSI standard and +100% of federal proverty level
QWDI recipients do not pay medicare part a permiums
remittance advice details medicaid's reimbursement on claim. law set by state. attached to medicaid claim after otehr insurance is billed
SCHIP covers children up to 19
SLMB recipients do not pay medicare part b peremiums
TANF provides cash assistance for children whose parents are unable to care for them
utilization survey sent to medicaid patients to verity services received in month prior
voided claim claim that medicaid should not have paid
EPSDT early periodic screening diagnostic treatment
FMAP federal medical assistance percentage
QI qualified individual
QMB qulified medicare beneficiary
SCHIP state children health insurance program
SLMB specified low income medicare beneficiary
SSI supplemental security income
TANF temporary assistance for need families
medicaid may have to pay copay, co-insurance, deductible, or permium
establishes the max payable amount for each medicare service state
medicaid covers medical services
optometrist optional service
family planning services and supplies mandatory service
verify eligibility of patient's medicaid every visit
any questions about medicaid should be addressed to the local county government
a baby born to medicaid eligible mother receives coverage for one year
medicaid is not free for just anyone who is medically needy. (must be blow federal proverty level)
medicaid if different from state to state (different state administer things differently)
8 federal requirements for medicaid TANF
8 federal requirements for medicaid pregnant + below federal poverty level
8 federal requirements for medicaid caretakers/children below fpl
8 federal requirements for medicaid SSI recipient
8 federal requirements for medicaid medically needy + below fpl
8 federal requirements for medicaid special groups
8 federal requirements for medicaid foster family
8 federal requirements for medicaid instiutionalized individuals
medicare coverage categories mandatory
medicare coverage categories optional
medicare coverage categories preauthorized
ways to verify medicaid eligibility telephone
ways to verify medicaid eligibility internet
ways to verify medicaid eligibility point of service (card swiper)
subrogation assuming an obligation when another party is liable
Created by: quece79