This depends on whether we are talking about Professional Billing or Hospital Billing. Generally charges are grouped together by admission for HB, so you would check the coverage status for the admission. DNB means do not bill. And there can be multiple coverages depending on the admission, or no coverage at all.
However, you're looking for clinic data, so it's best to look at PB, not HB. But there are exceptions to that rule. For example, one might have a Hospital Outpatient Visit (HOV) or the like. For PB, charges drop onto a guarantor account. These charges are for all services. You'd need to see which is the primary, secondary, etc... coverage on the guarantor account (active of course). Generally, as the payors pay the claim off, an NRP (next responsible party) action moves the responsibility of the claim. Generally, the patient is responsible once the insurance companies have paid their portion, but this doesn't need to be at the end of the revenue cycle. But if you are excluding patient responsibility, that could be left alone. So the insurance status continues to change over time. Depending on the i2b2 load, it would be important to find out the status at that point in time. The first of the month is a good time for PB, since most organizations like to make sure things are up to date on their general ledger by the 1st of the month. ________________________________________ From: [email protected] [[email protected]] on behalf of Dan Connolly [[email protected]] Sent: Thursday, July 03, 2014 12:08 PM To: [email protected] Subject: RE: [gpc-informatics] #139: insurance status I don't know how to get insurance status from clinic data at KU. Do any other sites have this data? Which part of the clinical workflow do you get it from? Is it stored in Epic? If so, where? If not, where? -- Dan ________________________________________ From: GPC Informatics [[email protected]] Sent: Thursday, July 03, 2014 11:12 AM To: Dan Connolly Cc: Russ Waitman; [email protected] Subject: [gpc-informatics] #139: insurance status #139: insurance status --------------------------+---------------------------- Reporter: dconnolly | Owner: dconnolly Type: enhancement | Status: new Priority: major | Milestone: Component: data-stds | Keywords: obesity-cohort Blocked By: | Blocking: 33 --------------------------+---------------------------- This has come up in recent discussions: Dan Hale Wednesday, July 02, 2014 5:11 PM: > ... > Furthermore during this progression, does the population drift toward middle class, insured, white, suburban, etc. ... -- Ticket URL: <http://informatics.gpcnetwork.org/trac/Project/ticket/139> gpc-informatics <http://informatics.gpcnetwork.org/> Greater Plains Network - Informatics _______________________________________________ Gpc-dev mailing list [email protected] http://listserv.kumc.edu/mailman/listinfo/gpc-dev _______________________________________________ Gpc-dev mailing list [email protected] http://listserv.kumc.edu/mailman/listinfo/gpc-dev
