Insurance Tips and Tricks

Insurance Tips and Tricks

Common Plans

AETNA:

•  “W” as an alpha prefix

BlueCross Blue Shield (BCBS):

• 3 alpha prefixes OR will have an “R” alpha prefix
  
  
• REMINDERS: 
  • CareFirst BlueChoice Plans
    • Sterling - If Member ID starts with a single “A” as the alpha-prefix, select “CAREFIRST BLUE CHOICE”
    • Sterling - If plan is CareFirst Administrators, select “CAREFIRST BLUE CHOICE”
    • Sterling - If neither of the above applies, select “ANTHEM”
    • All other WR locations select “CAREFIRST BLUE CHOICE”
  • Anthem HealthKeepers Plans
    • All WR locations select “HEALTHKEEPERS”
  • Local/Out of State CareFirst, BlueCross BlueShield, Anthem Plans
    • Sterling – Select “ANTHEM BCBS OF VIRGINIA”
    • All other WR locations – Select “CAREFIRST BCBS”
  • BCBS Federal Plans
    • DO NOT use the Plan/Enrollment Code as the group number. If the group number is not listed on the card, leave that field blank.
      

CIGNA:

•  “U” as an alpha prefix

UNITED HEALTHCARE (UHC):

• Policy number: “Member ID”

HUMANA:

• “H” as the alpha prefix

AMBETTER SUPERIOR HEALTH:

• “U” as an alpha prefix
• Do not enter the “Policy #” from the card, instead the “Member ID”

TRICARE:

• Policy number will be the benefits number on the back of the card
• If it is not, use the primary policy holder’s social security number

EHE International/EHE Health:

• This is NOT a charity or non-profit
• We ARE contracted with EHE and there is a payor code in Merge
  • EHE INTERNATIONAL
    
    

GOVERNMENT EMPLOYEES HEALTH ASSOCIATION (GEHA):

•  Do not enter the letters "GEHA" at the end of the policy number. 

INSURANCE NOT FOUND IN MERGE (FREEFORM):

• Be sure to reference the OON List BEFORE adding a "freeform" insurance
  • Washington Radiology Out-of-Network Insurance List 
• ADD NOTE TO INCLUDE:
  • Insurance Name
  • Insurance Policy Number (Member ID)
  • Provider/Precertification Phone Number
  • Claims billing address from card
• Do not use for major payors, such as Aetna, UHC, Cigna or BlueCross BlueShield, etc.

MEDICARE:

MEDICARE TRADITIONAL-SELECTING IN MERGE RIS:

MEDICARE - TRADITIONAL PLAN:

• For Patients 65 + years of age
• Patient is always the primary holder of Traditional Medicare

MEDICARE - REPLACEMENT PLAN:

• Medicare Replacement Cards – REPLACE Traditional Medicare
• Look for Medicare Complete or Medicare Advantage
• Never file with Traditional Medicare if it is a Replacement plan

MEDICARE - SUPPLEMENT PLAN:

• Medicare Supplement Cards – ADD to Traditional Medicare
• Secondary to Traditional Medicare
• Patient will have Traditional Medicare Primary and Supplement Secondary
• Will typically state “Medicare Supplement” on card

MEDICAID

WE DO NOT ACCEPT MEDICAID AT WASHINGTON RADIOLOGY
The only exception would be John Hopkins Priority Partners Medicaid Plan

ANY plans with the following prefixes are NOT accepted. These are Medicaid plans through BCBS.

• For Virginia:
  • YTD
  • YTE
  • YTF
  • YTW
  • JKW
  • JTD
  • YRC
  • VAQ
• For Maryland:
  • MDD

UPDATED: 10/22/2024