Funda ngalezi Zaziso Zemangalo Yezokwelapha
Iseluleko sokuThumela (RA) ngumqulu ohlinzekwa ngumkhokheli womshuwalense ohlinzeka isaziso kanye nokuchaza ngezizathu zokukhokha, ukulungiswa, ukuphika kanye / noma ukuthola izindleko zesimangalo sezokwelapha. Ngokuvamile kuhambisana ne-Medicare ne- Medicaid izinkokhelo . Kuvame ukubhekwa njengenkcazelo yokukhokha (EOB) ngabanye abakhokhisi bomshuwalense.
Izinhlobo Zokunikezwa Kwezibonelelo
- Iseluleko se-Electronic Remittance (ERA): i-RA ethathelwa ngefomethi ye-elekthronikhi
- Iseluleko Esijwayelekile Sokuthunyelwa Kwezimpahla (i-SRA): i-RA ethunyelwe kwifomethi yephepha
Abaningi bomkhokhwa yomshuwalense basebenzise ukusetshenziswa kwe-ERA. Izinzuzo zihlanganisa ikhono lokuthumela ulwazi lokukhokha ngokuzenzekelayo futhi ngokushesha zikhomba ukuphika okwenziwe ngesikhathi sokukhokha kokuqala ukwenza izilungiso ezidingekayo.
I-ANSI 835 yi-elekthronikhi yokukhokha kanye neseluleko sokukhishwa kwemali esilinganisweni sezindleko zokunakekelwa kwezempilo. Imithethonqubo ye-HIPAA idinga ukusetshenziswa kwe-835 njengemithetho ebekiwe yokufaka esikhundleni sephepha le-EOB uma abahlinzeki bempilo behola izinkokhelo ze-elektroniki.
Okufakiwe ku-Advice Remittance
Iseluleko sokubuyiswa kufanele sihlanganise ezinye noma lonke ulwazi olulandelayo:
- Isamba esikhokhelwayo: Inani lemali elikhokhelwa ngumkhokhi
- Inani elivunyelwe: Inani elivunyelwe lilingana nesamba semali yesamba esivunyelwe ngumkhokhi
- Inani elivunyelwe: inani elivunyelwe lilingana nesamba semali yesamba esivunyelwe ngumkhokhi
- Isibopho Sokubekezela Umthamo: inani lemali oyisibopho sesiguli esimele ikhophi yesiguli, imali yezimali , kanye nezindleko ezikhishiwe
- Inani elihlanganisiwe: inani elihlanganisiwe lilingana nenani lesibalo esiphezulu esasihlanganiswa nomkhokhi
- Inani lesaphulelo: inani le-dollar lesaphulelo sokukhokha okuyinhloko noma ukulungiswa kwesivumelwano
- Usuku lokumangalelwa: usuku olufunwa ngalo lubekwe isigwebo futhi / noma lukhokhwe
Iseluleko sokukhipha imali singabonisa nabanikazi benkampani yangaphakathi yokulawula (i-ICN), hlola inombolo, amakhodi wenkonzo, incazelo yamasevisi, amakhodi wokuphika, futhi uchaze izincazelo.
I-Advice Remittance Advice (ERA)
Ukusebenzisa iseluleko se-electronic remittance (ERA) kuyindlela esheshayo nenembile yokuthumela izinkokhelo zakho kanye nokulungiswa nokuphika. I-ERA, Nokho, ayiphumelelanga ngaphandle kokudluliselwa kwemali kagesi (EFT). I-EFT izoqinisekisa ukuthi inkokhelo yakho izothumela ngqo ku-akhawunti yakho yasebhange ukuze ibonise i-ERA yakho. Ungabhalisela lezi zinzuzo ngqo noma ngokusebenzisa indlu yokuhlanza. Inqubo izosebenza ngendlela efanayo nenqubo yokukhokha nge-electronic.
Isibonelo: Iseluleko Sokuthunyelwa Kwesampula
Lesi seluleko sokukhishwa kwesampula sibonisa ulwazi oluyisisekelo, amagama esigaba kanye nolunye ulwazi lungase luhluke ngokusekelwe kumkhokheli womshuwalense.
ABC INSURANCE COMPANY
IGAMA LOMPATI: UJOHN DOE
I-ACATI ye-PATIENT: 123123123
I-MEMBER ID CHA: 554554554
I-PAYER I-ICN CHA: 123456789XYZ
UMHLA WESIVIV: 01/01/2012
UMHLABA WOKUSAYELA: 01/15/2012
I-DESCRIPTION YENKONZO: I- OFISI YOKUVELA
IZIKHATHI ZAMAHLA: $ 100.00
I-AMOUNT EVIKELWE: $ 80.00
I-DISCOUNT AMOUNT: $ 20.00
I-COPAY: $ 20.00
IZINTO: $ 8.00 (10%)
UKUPHATHISWA KWEZINDABA: $ 28.00
I-AMOUNT AMOUNT: $ 52.00
AMAKHUMBI
UKUKHALWA KWEKHAYIBHELI KUVUMELANA NOKUBHALA
Eminye imigomo ehlobene ne-Remittance Advice ihlanganisa:
- Inombolo ye-akhawunti: inombolo enikezwe isiguli ngasinye ukuvakashela ukukhomba amacala nezinkokhelo ezenziwe ngosuku oluthile lwenkonzo.
- I-Coinsurance: ibonisa indlela umshwalense kanye ne-insured abahlukanisa ngayo izindleko zebhilidi lezokwelapha ngemva kokudonswa kwe-deductible. Uma sekufinyelelwe isikhala esiphezulu se-pocket umqashi uyothola umthwalo wemali ngamaphesenti angu-100 kwanoma yiziphi izindleko ezengeziwe.
- I-Copayment: Inani lemali elikhethwe uhlelo lwempilo yomshuwalense ngesiguli ukukhokhela insizakalo ecacisiwe, ngokuvamile isamba esicacile.
- I-Deductible : ingxenye yesimangalo esingahlanganiswa nomhlinzeki womshuwalense futhi kufanele ikhokhwe yi-insured ngaphambi kokuba izinzuzo zenqubomgomo zingasebenza.