1. Copyright © 2008 Delmar Learning. All rights reserved. Chapter 12 Commercial Insurance

2. Copyright © 2008 Delmar Learning. All rights reserved. 2 Introduction This chapter is going to be talking about how to complete fee-for-service claims

3. Copyright © 2008 Delmar Learning. All rights reserved. 3 Processing Commercial Claims Separate instructions for primary, secondary, and supplemental commercial insurance plans. Instructions in a table format for completing claims.

4. Copyright © 2008 Delmar Learning. All rights reserved. 4 Processing Commercial Claims A case study and completed claim to illustrate the instructions Give a plain and a completed claim to the students to practice completing a claim Completed claims allow the students to receive feedback

5. Copyright © 2008 Delmar Learning. All rights reserved. 5 Commercial Claims Determined by one of the following criteria: –Patient is covered by one commercial plan –Patient is covered by a large employer group health plan and also Medicare beneficiary –Patient is covered by a small or large employer health plan and is the policy holder Patient is also listed as a dependent on another EGHP

6. Copyright © 2008 Delmar Learning. All rights reserved. 6 Commercial Claims Determined by one of the following criteria: –When the patient is a child who is covered by two or more plans –Primary policyholder is the parent whose birthday occurs first in the year

7. Copyright © 2008 Delmar Learning. All rights reserved. 7 Commercial Secondary Coverage Changes are made to the CMS-1500 claim when patients are covered by primary and secondary or supplemental health insurance plans.