EPIC Study Guide
MCO - ANS-Managed Care Organization
Nine Maryland MCOs - ANS-Aetna Better Health, Amerigroup, Jai, Kaiser, MedStar
Family Choice, MD Physicians Care, Priority Partners, UHC MCO, CareFirst
Community Health Plan
Five Maryland MCOs that have a separate policy # than the MA# - ANS-Amerigroup,
Kaiser, MedStar Family Choice, Priority Partners, UHC MCO
Three processes for verifying MA eligibility - ANS-EVS Web, EVS Phone, RTE
Four types of patients that we EVS - ANS-MA, Medicare no secondary, Prisoners,
Self-Pay
Who do we bill for behavioral health for MA? - ANS-Optum Health
SLMB; Who do we bill? - ANS-Specified Low-Income Medicare Beneficiary; Medicare
ONLY!
QMB; Who do we bill? - ANS-Qualified Medicare Beneficiary; Medicare and MA
Who is the subscriber for MA? - ANS-The patient; Except newborns within 30 days of
life
If a patient presents a Medicare card and a Medicare Advantage card, what would the
insurance selection look like? - ANS-Medicare Advantage ONLY!
IMM - ANS-Important Message from Medicare
What is the deadline for getting the IMM signed? - ANS-Within 48 hours of inpatient
admission
MSPQ - ANS-Medicare Secondary Payor Questionnaire
What is the purpose of the MSPQ? - ANS-To determine if Medicare pays primary
GHP - ANS-Group Health Plan
MCO - ANS-Managed Care Organization
Nine Maryland MCOs - ANS-Aetna Better Health, Amerigroup, Jai, Kaiser, MedStar
Family Choice, MD Physicians Care, Priority Partners, UHC MCO, CareFirst
Community Health Plan
Five Maryland MCOs that have a separate policy # than the MA# - ANS-Amerigroup,
Kaiser, MedStar Family Choice, Priority Partners, UHC MCO
Three processes for verifying MA eligibility - ANS-EVS Web, EVS Phone, RTE
Four types of patients that we EVS - ANS-MA, Medicare no secondary, Prisoners,
Self-Pay
Who do we bill for behavioral health for MA? - ANS-Optum Health
SLMB; Who do we bill? - ANS-Specified Low-Income Medicare Beneficiary; Medicare
ONLY!
QMB; Who do we bill? - ANS-Qualified Medicare Beneficiary; Medicare and MA
Who is the subscriber for MA? - ANS-The patient; Except newborns within 30 days of
life
If a patient presents a Medicare card and a Medicare Advantage card, what would the
insurance selection look like? - ANS-Medicare Advantage ONLY!
IMM - ANS-Important Message from Medicare
What is the deadline for getting the IMM signed? - ANS-Within 48 hours of inpatient
admission
MSPQ - ANS-Medicare Secondary Payor Questionnaire
What is the purpose of the MSPQ? - ANS-To determine if Medicare pays primary
GHP - ANS-Group Health Plan
