Epic: Insurance Points to Remember and Coordination of Benefits (COB)

BCBS correct answer: Has insurance cards with 1-5 (usually 3) alpha characters preceding the ID number which need to be included when loading/verifying the insurance. Out of state BCBS plan correct answer: Don't automatically use BCBS out of state option; if claims billing address states to file thru local office, then use BCBS of TX option Tricare correct answer: Insurance for active duty military and their dependents and retired military and their dependents; administrated by Humana Military Healthcare Services (HMHS) Insurance card for Tricare correct answer: Patient's military ID; policy # is the sponsor's SSN (except those issued after 2011 have a DoD ID# on the back of the military ID instead); there is no group # Civilian indicator correct answer: Located on the back of the military ID; if NO, then patient is active duty and require a referral from Tricare; if YES, then the patient can come to a civilian facility for medical care FO for commercial insurance and Tricare correct answer: Commercial insurance pays primary to Tricare FO for Tricare and Tricare supplement correct answer: Tricare is primary to a Tricare supplement Subscriber to Tricare correct answer: The service person Dependent Children with Tricare correct answer: If under age 10, use parent's military ID card; if over age 10, will have own card; if divorced parents, child will have own card regardless of age Tricare Prime correct answer: Beneficiaries will have military ID plus Tricare Prime card; Tricare Prime Retirees will have a $12 copay at any provider based SW clinic. Patients must select a PCM for primary care and specialty care requires a referral from the PCM. After Oct 1, 2013, must choose a PCM at Darnall if live in 76544 zip code or within 20 mi of Darnall. If eligible prior to Oct 1, 2013, then may keep PCM if within PSA. Must get referral authorization thru HMHS Military ID expiration date correct answer: If indefinite expiration date for Retirees and their dependents, continue to use the sponsor's SSN. If the card is expired, do not enter Tricare. If the military ID has expired but patient had Tricare loaded into scheme, verify using RTE, the website or Passport OneSource