1. From Registration to Accounts Receivable – The Whole Can of Worms 2007 UBO/UBU Conference 1 Briefing:The Standard Insurance Table – Case Studies Date:20 March 2007 Time:1110 - 1200

2. 2007 UBO/UBU Conference From Registration to Accounts Receivable 2 Objectives Understand the importance of the information entered into the SIT Table Know the common data entry errors and how to avoid them Learn basic rules through “hands on” sample screens

3. 2007 UBO/UBU Conference From Registration to Accounts Receivable 3 Outline Brief review of the SIT Table Review HIC Entry Fields Review SIT Table Basic Business Rules Identify common HIC Entry errors Review sample HIC entries Role of Verification Point of Contact (VPOC)

4. 2007 UBO/UBU Conference From Registration to Accounts Receivable 4 Standard Insurance Table

5. 2007 UBO/UBU Conference From Registration to Accounts Receivable 5 Standard Insurance Table SIT Important Facts: – List of Health Insurance Carriers (HIC) – Stored on Defense Eligibility and Enrollment Reporting System (DEERS) – Accessed via the local Composite Health Care System (CHCS) – Bi-directional flow of information – Contains the claims address of the HIC which is necessary for billing Other Health Insurance (OHI) – OHI is “pointed” to a corresponding HIC for the claims address – Bill is sent to insurance company requesting payment

6. 2007 UBO/UBU Conference From Registration to Accounts Receivable 6 Information Flow CHCS 1 TDEFIC & MCSCs Claims DOES MCSCs & DP PDTS Local OHI Local SIT TPOCS Master SIT OHI DEERS Local OHI Local SIT Local OHI Local SIT Local Holders of the SIT: Subscribe daily to DEERS for updates to the SIT VPOC validates and approves all adds/updates to the Master SIT

7. 2007 UBO/UBU Conference From Registration to Accounts Receivable 7 HIC Entry Fields Verification Point of Contact (VPOC) and Composite Health Care System (CHCS) Views

8. 2007 UBO/UBU Conference From Registration to Accounts Receivable 8 HIC Entry / VPOC View

9. 2007 UBO/UBU Conference From Registration to Accounts Receivable 9 HIC Add Screen CHCS View SIT ID: STANDARD INSURANCE TABLE ADD INS COCHCS Insurance Company Name: Aetna Health Care Additional Description: State School System Carrier Website: www.aetna.com Customer Service Email: www.customer.aetna.com HIC Status Code: T (Temporary) HIC Verification Code: U (Unverified) Coverage/Payer Type: XM/B (Medical – Inst/Prof) HIC Loc Commt: Local MTF HIC Std Commt: VPOC (Verification POC)

10. 2007 UBO/UBU Conference From Registration to Accounts Receivable 10 Cov Add Screen CHCS View SIT ID: AETCA0034 STANDARD INSURANCE COMPANY ADD INS CO CHCS Insurance Company Name: AETNA HEALTH CARE Coverage Type: MEDICAL Payer Type Code: B (BOTH) INSTITUTIONAL AND PROFESSIONAL Coverage Status Code: T Coverage Verification Status: U ATTN: Medical Claims P.O. Box/St Address: PO BOX 246 Zip Code: 92121 Zip Ext: State/Country: CALIFORNIA City: SAN DIEGO Phone Number: 8581021928 Phone Ext: FAX Number:

11. 2007 UBO/UBU Conference From Registration to Accounts Receivable 11 Point of Contact CHCS Screen Last Update System Name: system name of current user defaults here Last Update User Name: current user name defaults here Last Update User Phone: 7035751710 Ext: Last Update User Email: theresa.boyd@altarum.org

12. 2007 UBO/UBU Conference From Registration to Accounts Receivable 12 Basic Rules/Data Quality Basic Business Rules And Data Quality

13. 2007 UBO/UBU Conference From Registration to Accounts Receivable 13 Basic Rules/Data Quality Spell out entire name of insurance carrier Avoid use of acronyms unless actual name No punctuation, symbols, hyphens Include Point of Contact (POC) name and commercial telephone number Include valid insurance carrier telephone number Be specific in the Attention Line Limit adding any insurance carriers billed only under Medical Affirmative Claim (MAC) Do not add any JAG offices For “Out of State Claims” (Attn Line), use the state code where the services were rendered

14. 2007 UBO/UBU Conference From Registration to Accounts Receivable 14 Common HIC Entry Errors Identify Common HIC Entry Errors

15. 2007 UBO/UBU Conference From Registration to Accounts Receivable 15 Common HIC Entry Errors – Incomplete queries with duplicate HIC entries – Insurance carrier name is abbreviated – Use of “RX” prefix – RXAetna for insurance carrier – Use of commas, periods, symbols, 18002345678 – Use of DSN instead of commercial telephone number – Invalid insurance carrier telephone number – Incorrect Coverage Type - XM, MD entered and insurer is clearly Pharmacy – Failure to “cancel” an incorrect entry

16. 2007 UBO/UBU Conference From Registration to Accounts Receivable 16 Examples Sample HIC Entries for Review Using VPOC Screens

17. 2007 UBO/UBU Conference From Registration to Accounts Receivable 17 Examples

18. 2007 UBO/UBU Conference From Registration to Accounts Receivable 18 Examples

19. 2007 UBO/UBU Conference From Registration to Accounts Receivable 19 Examples

20. 2007 UBO/UBU Conference From Registration to Accounts Receivable 20 Examples

21. 2007 UBO/UBU Conference From Registration to Accounts Receivable 21 Examples

22. 2007 UBO/UBU Conference From Registration to Accounts Receivable 22 Examples

23. 2007 UBO/UBU Conference From Registration to Accounts Receivable 23 Examples

24. 2007 UBO/UBU Conference From Registration to Accounts Receivable 24 Examples

25. 2007 UBO/UBU Conference From Registration to Accounts Receivable 25 Examples

26. 2007 UBO/UBU Conference From Registration to Accounts Receivable 26 Examples

27. 2007 UBO/UBU Conference From Registration to Accounts Receivable 27 VPOC Queue

28. 2007 UBO/UBU Conference From Registration to Accounts Receivable 28 VPOC Queue

29. 2007 UBO/UBU Conference From Registration to Accounts Receivable 29 VPOC Queue

30. 2007 UBO/UBU Conference From Registration to Accounts Receivable 30 VPOC Verification Point of Contact (VPOC) Role

31. 2007 UBO/UBU Conference From Registration to Accounts Receivable 31 VPOC VPOC Role – Verifies claims address, when possible – Ensures data quality prior to SIT Table entry – Contacts User POC for any questions – Provides insurer information in the Standard Comment field – Updates, Adds, Restores, Rejects an entry

32. 2007 UBO/UBU Conference From Registration to Accounts Receivable 32 New Plans Proposed changes to SIT Table process: – When DEERS eligibility is completed, the OHI will automatically be searched and retrieved – Establish a VPOC to User communication system – Some field changes, etc – Education and training will be provided

33. 2007 UBO/UBU Conference From Registration to Accounts Receivable 33 TMA/UBO Web Site The new TMA / UBO Web site – http://tricare.osd.mil/ocfo/mcfs/ubo/index.cfm http://tricare.osd.mil/ocfo/mcfs/ubo/index.cfm

34. 2007 UBO/UBU Conference From Registration to Accounts Receivable 34 TMA/UBO Web Site

35. 2007 UBO/UBU Conference From Registration to Accounts Receivable 35 TMA/UBO Web Site

36. 2007 UBO/UBU Conference From Registration to Accounts Receivable 36 Helpful Tips Remember to: – Query the SIT Table to avoid duplicates – Use the commercial telephone number for POC – Obtain a valid insurance carrier telephone number – Use local comment field for additional information – Cancel an entry when it is a mistake – Do not deactivate any Health Insurance Carriers (HICs) – Limit request for any updates – When in doubt, contact VPOC

37. 2007 UBO/UBU Conference From Registration to Accounts Receivable 37 Summary Understand the importance of the information entered into the SIT Table Know the common data entry errors and how to avoid them Learn basic rules through “hands on” sample screens

38. 2007 UBO/UBU Conference From Registration to Accounts Receivable 38 Quiz True or False Always use the commercial telephone number for POC Use the Local Comment field for additional information and to communicate with the VPOC Do not add Judge Advocate (JAG) offices