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Prelude Q&A


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Medicaid pending:

Remember this is an account status and is entered in the guarantor record.

  • From registration select the guarantor account.
  • Click in the Account status field (top right) and select Medicaid Pending.

Important note: Any person who flags an account as Medicaid pending will have to go into the billing module and set the billing status appropriately.

  • Billing>Account Contact
  • Select the ellipsis in the New Activity field (Choose: Billing Status)
  • Click Add Activity-In the billing Status choose "Don't Age and Send Statements." This ensures the patent continues to receive their bill while awaiting Medicaid approval.

Once approved/denied for Medicaid, the account status must be removed and the billing status must be changed to "Age and Send Statements."

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 Sherpa:

Sherpa will be a guarantor account, named ECU Sherpa, and the coverage will need to be attached to this account.

  • Go to the Blue guarantor folder
  • Click Add
  • Choose Add'l Type
  • Choose ECU Sherpa from category list
  • Enter the person that is the employee
  • Click Cvg and Add'l Info and enter the coverage-This could be the employee or the patient.

 

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Special Programs:

S-CAP, LME, Cancer Fund, Migrant Workers and Ryan White will all have a P/F guarantor account with the applicable coverage record attached.

If a patient has Ryan White or S-CAP, that co-payment will be made with the "other payment" button during check-in. Users will need to post that payment through the later distribution method.

 

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Payors Eligible for Electronic Verification

1. Aetna
2. BCBS
3. BCBS Out of State
4. Cigna
5. Humana Gold
6. Humana HealthCare
7. Mamsi
8. Medicaid
9. Medicare Managed Care
10. Medicare Secondary
11. Medicare GEHA
12. Medicare Nylcare Health Plan
13. Medicare, UMWA
14. Palmetto GBA (UHS coverage: WE DO NOT VERIFY THIS PAYOR)
15. Tricare
16. United Healthcare
17. Cigna Medicare Part B

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Adding A Corporate Account - During Check-In Process

1. From the DAR select patient
2. If it is within 30 days and the system auto-branches you to the Check-In screen, click on Reg from the toolbar.
3. Click on the blue guarantor folder.
4. Click on Add.
5. From the first row, select the radio button next to Add'l type
6. From the selection list, select Corporate.
7. From the second row, select the radio button next to Other.
8. From the selection list, select Other.
9. The Guarantor Information fields open up.
10. In the Name/ID field, enter the Corporate Account name.
11. Click on Find Existing Account.
12. Click Accept.

*You do not need to add an insurance to a corporate guarantor.

 

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Selecting the Corporate Account at Charge Entry

1. If when entering a Company Account during charge entry and the Company Account is not found in your search (it's a new one), you will need to enter a OneStop to have the hospital create the Company Account.

2. For those of you that have Company Accounts in your WQ, or holding charges due to Company Account, please see the below resolution:

  • when entering charges, click on the ellipsis button next in the coverage field.

 

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Adding a Kidney Acquisition - During Check In Process

1. From the DAR select patient.
2. If it is within 30 days and the system auto-branches you to the Check-In screen, click on Reg from the toolbar.
3. Click on the Blue guarantor folder
4. Click on Add.
5. From the first row, select the radio button next to Add'l Type
6. From the selection list, select Corporate.
7. From the second row, select the radio button next to Other
8. From the selection list, select Other.
9. The Guarantor Information fields open up.
10. In the Name/ID field, enter Acquisition, Kidney.
11. Click on Find Existing Account.
12. Click Accept.

*You do not need to add an insurance to the guarantor.

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Adding an Organ Donor - During Check In Process
For purpose to Harvest Organs

1. From the DAR select patient.
2. If it is within 30 days and the system auto-branches you to the Check-In screen, click on Reg from the toolbar.
3. Click on the Blue guarantor folder
4. Click on Add.
5. From the first row, select the radio button next to Add'l Type
6. From the selection list, select Corporate.
7. From the second row, select the radio button next to Other
8. From the selection list, select Other.
9. The Guarantor Information fields open up.
10. In the Name/ID field, enter Carolina Organ Pro Agency.
11. Click on Find Existing Account.
12. Click Accept.

*You do not need to add an insurance to the guarantor.

 

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I. Injury Dates on the Claim Info Record (Please see the below forms that need to be completed):

1. For Worker's Compensation
     A. Complete the Accident Form
          -Accident Type
          -Date of Injury
          -Address
          -Informant-if you have this
     B. and the Worker's Comp General Form
          -Employment related
          -WC Claim
          -Employer

2. Auto Accident
     A. Complete the Accident Form
          -Accident Type
          -Date of Injury
          -Informant-if you have this

3. Other Injury
     A. Complete the Payor General Form
          -Illness/Injury/LMP & date field
          -Date

II. Date of Death

1. You may force the Date of Death edit out of the WQ's-this includes the ones you had previously submitted, go ahead and force resubmit those out.

***CAUTION: If there are other "Rules" on your patient in the CRWQ, make sure they are fixed before you force resubmit.

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How to get the PCP edit off your WQ:

In Registration:

  • Highlight the PCP
  • Click Remove PCP (note the effective date)-you will get a warning-Select Yes.
  • Select Add/Change PCP
  • You will be taken to the PCP Change Screen 

 

 Enter the New PCP again

  • Enter the Effective Date again
  • PCP Type: Enter General  (This should be the default, don't change it!)
  • Accept
  • Accept
  • Finish

 

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Registering a Medicare Secondary Patient

Secondary Medicare is where "Cigna Medicare-Brody Only" (Payor 1165) will be filed as the second insurance.

1. In HealthSpan, you will use the "Cigna Medicare-Brody Only" (payor 1165) to register Medicare secondary patients. Note: We will use the same plan for all Cigna Medicare patients, regardless of filing order!

2. After filling out the information in the "Subscriber Info" page, you will need to navigate to the "Additional Information" page and complete the "Med Sec Ins Type" which records the Medicare Secondary Reason Code.

To add Cigna Medicare as Secondary:

  • Click on Cvg & Add'l Info
  • Click on Add
  • Enter M81 in the Coverage name field
  • Click on Search
  • Select Cigna Medicare
  • Click on Edit and complete the screen
  • Click on Next
  • Click on Next
  • System will branch to the Additional Info screen of the Coverage Wizard
  • Click on the Med Sec Ins Type and select appropriate type:

 

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How to Remove Address Edit from WQ:

All addresses need to be placed on line 1 of the Address Field in the Demographics screen. If the address is too long and flows to a second line, start from the end of the address and remove any vowels until the address is only on Line 1. If it appears that there is only one line and you are still getting the edit, highlight and cut the address, and press the backspace key until you see the yellow yield sign. Then paste the address back into the field and click Finish.

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