Coventry Health Care

Basics for Medical Billers

Coventry Health Care, Inc. inoshandisa zvirongwa zvehutano zvakasiyana siyana, makambani einishuwarenzi, uye makambani ekubhadhara mari yevashandi mune zvese makumi mashanu. Vashandi vezvokurapa vangangodaro vanoda kutumira zvinoreva kambani iyi. Vanopa webhusaiti yepamutemo yekuita zvakawanda zvemabasa aya.

Kune zvirongwa zvehutano zvakasiyana zvakasiyana-siyana izvo zvinowira pasi peMushambadzi weCoventry, kubva kuBoka Health Plan kusvika kuAmerican Postal Workers Union. Kubvira pakuregererwa kwemutemo, kubvunza zvipo, kugadzirisa zvikwereti uye kudzorera, chii chaunofanira kuziva pamusoro peCoventry uye ungawana sei ruzivo rwakananga rwaunoda? Ngatitange nokutaura pamusoro pezvirongwa zvipi zvinosanganiswa, nzira yekuwana ruzivo rwekuwanda, uye paunokwanisa kutungamirira mimwe mibvunzo yako kuti uwane mhinduro dzaunoda.

Kana iwe uri kutsvaga ruzivo rwekugadzirisa hutano hwakaoma hwehutano inshuwarheni, uri kuburikidza nekuongorora zvakananga zveurongwa hwehutano hwehutano .

1 -

Zvirongwa Zvichibatanidza Pasi peCoventry Health Care

Sezvakawanda nemakambani ehutano ema inshuwarisi ehutano, Coventry Health Care ikambani huru inosanganisira zvirongwa zviduku zvakawanda. Mamwe (asi kwete ose) eaya anosanganisira:

• Coventry Health Care National Network
• First Health Network
• Shanduro yeMabhadharo Inobatsira Mapepa
• Altius
• Carelink
• Coventry Health Care yeDelaware, Florida, Georgia, Iowa, Kansas, Louisiana, Nebraska, Nevada
• Coventry Health and Life of Oklahoma, Tennessee
• Coventry Missouri
• Gira Health Health Plan
• HealthAmerica / HealthAssurance
• PersonalCare
• Southern Health Services
• University of Missouri
• WellPath
• Sangano Rinobatsira Purogiramu
• Wekune dzimwe nyika Service Benefit Plan
• Rural Carriers Benefit Plan
• Strategic Outsourcing, Inc
• American Postal Workers Union (APWU)
• Kutanga Utano Health & Health Ins. Co.

2 -

Zvinyorwa Zvose pamusoro peCoventry Health Care

Nzira yakanakisisa yekuwana ruzivo rwehutano pamusoro pekubhadhara kwehutano neCoffry, taura kuGiro Rokubatanidza riri muChikamu 6 chemupiriridzi webhuku.

Nokuda Kwevatengi Vekutengesa Nyaya chinyorwa tsvaga kutarisa Customer Service Phone Number yakanyorwa pane imwe nhengo yedhidhi kadhi. Iyi Dhipatimendi ichakwanisa kukubatsira nemibvunzo yakanyorwa pasi apa uye nezvimwe zvinetso zvakawanda.

• Corrected Claims Issues
• Itemized Bills
• Nguva Yakadhindwa
• Kugadzirisa Matambudziko
• Anokumbira EOB uye RA
• Authorization Requirements
• Chengeta uye Kubhadharisa Matambudziko
• Batsirwa uye Nhengo dzeMhuri
• Initial Balance Kudzingwa Kwekuda
• Zvitsva Zvokupa Mupiro
• Bhuku Rekupa Mabhuku Anokumbira
• Non-Par Demographic changes
• NPI Mibvunzo

Kune Coventry National National Customer Service inoshandisa nhamba yerunhare iri kumashure kwekadhi kadhi reAdhi.

3 -

Kukodzera, Kubatsirwa uye Kutaura Kwemhosva

Kana iwe uri kunetseka kana imwe nzira kana mvumo yakavharwa (kukodzera), iyo yakawanda yekugoverwa (zvikwereti), kana kuti inofarira kudzidza kuti mamiriro ekutsvaga (chikonzero chekutsvaga), kune nzira nhatu dzokuwana ruzivo urwu.

1. Taura nhamba yefoni yakanyorwa pane imwe kadhi yeAdhi yemunhu.
2. Kuburikidza neCoventry Health Care muInternet Provider portal pane www.directprovider.com.
3. Kuburikidza neHhovisi Emdeon.

4 -

Preauthorization

Nhandare inowanzoda kushandiswa kwekugadziriswa kusanganisira chirwere chepachipatara kana kutarisirwa kwekucherechedza, kusarudzwa kwepachipatara (zvisinei nokuti rudzi rwekugadzirisa), yakakura mari radiology (yakadai seTCT, MRI, IMRT, Bone Density, Muviri Wose kana PET Scans), DME / Prosthetics / Orthotics, Kutarisira Kwenyika, Kutambudzika Kwemarwadzo, Kuvandudza (Mwoyo / Pulmonary / PT / OT / Kutaura), Kuongorora Kurara, uye mabasa anobatana neUkushaya kana Kuchinja.

Nzira Yokutumira A Precertification Chikumbiro

Zvikumbiro zvekugadziriswa zvinogona kuendeswa kuburikidza neCoventry Health Care yepaIndaneti inowanikwa purogiramu pawww.directprovider.com.

Kuti uwane mibvunzo yakananga, taura nhamba yekufanirwa kwepamberi yakanyorwa pane kadhi yeAdhi yechiri.

5 -

Mashoko Okubhadhara

Pane nzira nhatu dzinokosha umo mabhiriro angatumirwa:

1. Zvirongwa zvemagetsi zvinogona kutumirwa kuburikidza neCoventry Health Care yepaIndaneti purogiramu yekupa pa www.directprovider.com.
2. Kutaura kwekombiyuta kunogona kutumirwa kuburikidza nekuchenesa kwaEmdeon.
3. Pepanhau rinogona kuendeswa kuCeventry Health Care's claim yekuteerera kero yakanyorwa pane kadhi yeAdhi yemunhu.

Secondary claims anogona kuiswa nenzira dzinotevera:

• Tumira magetsi.
• Pepanhau rinogona kuendeswa neEOB primary payer.
• Itai kuti kugadziriswa kwezviyero zvose zviri muzvikwata zvekutsvaga uye nhare yepamusoro yebasa (kana iripo).
• Itai kuti zvikonzero zvigadziriswe zvakadai sekugadziriswa kwebvumirano, kubviswa, kuvimbiswa, kana vamwe. Shandisa zvinyorwa zvinopiwa nemutengo wekubhadhara mukuru.
• Mubhadharo wepamberi wakabhadharwa pazvikwata zviviri zvekutaura uye nhare yepamusoro yebasa (kana iripo).

6 -

Zvirongwa Zvokudhinda Zvenguva Ino

Nguva yekuisa mitsara inotsanangurwa mumushandi wekupa.

Sezvo ruzivo urwu ruchigona kuchinja nenguva kana kuti kusiyanana nekambani inenge iri, ita nechokwadi chekutarisa kuburikidza nechibvumirano chekupa zvezvinodiwa zvinodiwa.

7 -

Corrected Claims

Paunenge uchiita shanduko kune zvikwereti zvekare zvakabhadharwa, tumira zvinoruramiswa zvirevo zvemagetsi.

Dzorerai Frequency Code yekuda ne:
7 = Kuchinjwa kwechimbichimbi.
8 = Kuwanikwa / kukweta kwezvakaitwa kare.

8 -

Kudzorera

Kana iwe uchida kutarisira hutano hwehutano inshuwarheni, tumira mhinduro yakagadziriswa. Coventry Health Care ichadzorera / kudzosera kubhadharwa kuripo kuchazobvunzwa pamusoro peERA ine kupindurwa kwezvisina kukodzera kutongwa kwemhosva, inoteverwa nekugadziriswa kwekururamiswa kwemhosva.

Kubhadhara pamusana pezvikwereti zvekwereti zviripo zvinogona kutumirwa ku:

Taura neCoventry's Contract Grid iri muChitsauko 6 chebhuku rinopa.

9 -

Mashoko Okutsvaga

Kutsigira kukanganisa kurapwa kwezvokurapa izvi zvikwanganiso zvinogona kuongororwa kuburikidza neCoventry Health Care yemuchina wepaIndaneti yepaIndaneti pawww.directprovider.com kana kuti taura nhamba yefoni pane kadhi yeAdhi yerudzi kuti uwane ruzivo.

Endai kune chikamu cheMugovera weWebsite yeCoventry, pasi peElectronic Solutions, kuti uone EDI Documentation nezvimwe ruzivo rwakakosha uye zvisarudzo zvinowanikwa kwauri.

> Kwakabva:

> Coventry Health Care. http://www.coventryhealthcare.com/