Jun 10, 2023
OAT 255 - Medical Insurance IICredits: 3
Applies medical insurance billing processes and procedures using both manual and automated systems. Includes case studies, coordination of benefits, adjustments, deductibles, co-pays, posting of payments, and resolution of reimbursement problems.
Prerequisite(s): OAT 254 with a minimum grade of C (2.0).
Lecture Hours: 45 Lab Hours: 0
Meets MTA Requirement: None
Outcomes and Objectives
- Apply coordination of benefits rules to determine primary/secondary health insurance carrier responsibility.
- Determine and explain which health insurance carrier is billed first.
- Determine and explain which health insurance carrier is billed second, third, or fourth.
- Produce payable primary and secondary health claims for major health insurance carriers.
- Identify and explain appropriate charges for both primary and secondary health insurance carriers.
- Identify vital information and complete primary or secondary health insurance claims for commercial insurance carriers, Michigan Blue Cross Blue Shield, the Medicare program, and the Medical Assistance Program (Medicaid).
- Record health insurance carrier payments and perform account adjustments.
- Identify and interpret an explanation of benefits for each health insurance carrier.
- Determine amounts to be written off patients' accounts.
- Determine the patient’s and/or another insurer’s financial responsibility.
- Identify and use the appeals/error correction systems of the various health insurers.
- Identify how the claims processor corrects errors with each insurance carrier.
- Complete error correction claims for health insurance carriers.
- Demonstrate professionalism for the workplace.
- Participate in class.
- Follow written and oral directions.
- Complete and submit assignments on time.
- Participate constructively in activities.
- Display civility toward other class members and the instructor.
- Demonstrate academic integrity.
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