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Medical Insurance II

OAT 255

Medical Insurance II

OAT 255

Course Description

Prerequisite: OAT 254 with a minimum grade of C (2.0). Applies medical insurance billing processes and procedures using both manual and automated systems. Includes case studies, coordination of benefits, adjustments, deductibles, co-pays, posting of payments, and resolution of reimbursement problems. (45-0)

Outcomes and Objectives

Apply coordination of benefits rules to determine primary/secondary health insurance carrier responsibility.

Objectives:

  • Determine and explain which health insurance carrier is billed first.
  • Determine and explain which health insurance carrier is billed second, third, or fourth.

Produce payable primary and secondary health claims for major health insurance carriers.

Objectives:

  • Identify and explain appropriate charges for both primary and secondary health insurance carriers.
  • Identify vital information and complete primary or secondary health insurance claims for commercial insurance carriers, Michigan Blue Cross Blue Shield, the Medicare program, and the Medical Assistance Program (Medicaid).

Record health insurance carrier payments and perform account adjustments.

Objectives:

  • Identify and interpret an explanation of benefits for each health insurance carrier.
  • Determine amounts to be written off patients' accounts.
  • Determine the patient's and/or another insurer's financial responsibility.

Identify and use the appeals/error correction systems of the various health insurers.

Objectives:

  • Identify how the claims processor corrects errors with each insurance carrier.
  • Complete error correction claims for health insurance carriers.

Demonstrate professionalism for the workplace.

Objectives:

  • Participate in class.
  • Follow written and oral directions.
  • Complete and submit assignments on time.
  • Participate constructively in activities.
  • Display civility toward other class members and the instructor.
  • Demonstrate academic integrity.