Funda ngeeNkcazo zeMangalo zonyango
I-Advice Remittance (RA) nguxwebhu olunikezwa ngumhlawuli-nshurensi onika isaziso kunye nenkcazo yezizathu zokuhlawula, ukulungiswa, ukukhanyela kunye / okanye ukufumanisa iindleko zebango lezonyango. Ngokuqhelekileyo ihamba neentlawulo zeMedare and Medicaid . Ngokuqhelekileyo kubhekiselwa kuyo njengenkcazo yentlawulo (EOB) ngabanye abahlawuli bomshuwalense.
Iintlobo zeeNgcebiso zokuThumela
- Iseluleko se-Electronic Remittance Advice (ERA): i-RA ethathelwa kwifomathi yekhompyutha
- Iseluleko soMgangatho oMgangatho (i-SRA): i-RA efakwe kwifomathi yephepha
Uninzi lwabahlawuli bomshuwalense baye baqalisa ukusebenzisa i-ERA. Iintlawulo ziquka ukukwazi ukuthumela ulwazi lweentlawulo ngokuzenzekelayo kwaye ngokukhawuleza zichonge ukungafuni okwenziwe ngexesha lokuhlawula kuqala ukuze wenze izilungiso eziyimfuneko.
I-ANSI 835 yintlawulo yekhompyutheni kunye neengcebiso zenkxaso yefom yezinga eliqhelekileyo lamabango enkonzo. Imigaqo ye-HIPAA idinga ukusetyenziswa kwe-835 njengemigaqo yemigaqo yokufaka indawo yephepha le-EOB xa ababoneleli bezempilo befumana iintlawulo zekhompyutha.
Yintoni edibeneyo kwi-Advice Reminder
I-Advance Remittance kufuneka ifake ezinye okanye zonke iinkcukacha ezilandelayo:
- Inani lokuhlawula elihlawulwayo: Inani lemali ehlawulwa ngumhlawuli
- Imali evunyelweyo: Inani elivunyiweyo lilingana nemali yebango lonke elivunyiwe ngumhlawuli
- Inani elivunyelweyo: inani elivunyelweyo lilingana nenani lebango elipheleleyo elivunyelwe ngumhlawuli
- Isixanduva Somonde: Inani lemali enoxanduva lomguli ogxininisa i-copay yesigulane, i- coinsurance , kunye nexabiso
- Inani elifihliweyo: Imali efunyenweyo ilingana nesixa semali ebhaliweyo efunyenwe ngumhlawuli
- Inani lesaphulelo: ixabiso leedola lomlinganiselo wokuhlawula umvuzo wokuqala okanye ukulungiswa kwemvumelwano
- Umhla wokugweba: umhla ofunwa ngawo umgwebo kunye / okanye uhlawulwa
Iingcebiso zokuxhaswa nazo zingabonisa abahlawuli beenombolo zangaphakathi zolawulo (ICN), khangela inombolo, iinkonzo zenkonzo, inkcazo yeenkonzo, iikhowudi zokuchasana nezizathu, kwaye uchaze iinkcazo.
I-Advance Remittance Advice (ERA)
Ukusebenzisa isiluleko se-electronic remittance (ERA) yindlela yokukhawuleza neyochanekileyo yokuthumela iintlawulo zakho kunye nokulungiswa kunye nokukhanyela. I-ERA, nangona kunjalo, ayisebenzisi ngaphandle kokudluliselwa kwemali ye-elektroniki (EFT). I-EFT iya kuqinisekisa ukuba inkokhelo yakho iya kuthumela ngqo kwi-akhawunti yakho yasebhanki ukubonisa i-ERA yakho. Ungabhalisela ezi ntlawulo ngqo okanye ngokusebenzisa indlu yokucoca. Inkqubo iya kusebenza ngokufana nenkqubo yentlawulo yekhompyutha.
Umzekelo: Isiluleko seMali yokuThumela
Le ngcebiso isibonelelo sokukhupha ibonisa ulwazi olusisiseko, amagama eeklasi kunye nolunye ulwazi lungahluka ngokusekelwe kumhlawuli we-inshorensi.
ABC INKQUBO YOKUSEBENZA
IGAMA LOMPATI: UJOHN DOE
I-ACCT ye-PATIENT: 123123123
ISEBE SEBHUMBI: 554554554
I-PAYER ICN Hayi: 123456789XYZ
UMHLA WENTSHONA KWE-SVC: 01/01/2012
UMHLA WENTYELO: 01/15/2012
INKCAZELO YENKONZO: I- OFISI YOKUVELA
IINKCUKACHA ZONKE: $ 100.00
UKUKHULULELA AMOUNT: $ 80.00
I-AMOUNT AMOUNT: $ 20.00
COPAY: $ 20.00
IINKONZO: i-$ 8.00 (10%)
UKUPHATHWA KWEMPATIENT: $ 28.00
I-AMOUNT AMOUNT: $ 52.00
AMAKHUMBU
UKUKHALWA KWEENKCAZO NGOKUBHALISWA KWEZINTLOKO
Ezinye iziganeko ezinxulumene neNgcebiso yokuThumela iziNtu ziquka:
- Inombolo ye-Akhawunti: inani elinikezelwe kwisigulane ngasinye ukutyelela iintlawulo kunye neentlawulo ezenziwe ngomhla othile wenkonzo.
- I-Coinsurance: ibonisa indlela umgcini-inshurensi kunye ne-insured ekwahlula ngayo iindleko zecala lezonyango emva kokuba i-deductible idibeneyo. Emva kokuba i-out-of-pocket efikile ifikeleleke i-inshurensi iya kuthwala uxanduva malunga neepesenti eziyi-100 zeendleko ezongeziweyo.
- Ikopiyure: Inani lemali elikhethwe yiplani yezempilo yomshuwalense kwisigulana ukuhlawula inkonzo ethile, ngokuqhelekileyo isamba esicacileyo.
- I-Deductible : isabelo salo naliphi na ibango elingagqithwanga ngumniki-inshorensi kwaye kufuneka lihlawulwe ngumntu onesiqinisekiso ngaphambi kokuba iinzuzo zomgaqo-nkqubo zingasebenza.