MEDICAID

MEDICAID ELIGIBILITY

MEDICAID BENEFITS

Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

Prior Authorization

Medicaid Claims Filing Requirements

Medicaid Claims Completion Guidelines

Common Denials for Medicaid Claims

Medigap

Medigap Claims Processing

Cross-over

Medigap Transfer

EOMB

COBRA

TRICARE (FORMERLY CHAMPUS)

CHAMPVA
(THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERANS AFFAIRS)

DEPARTMENT OF DEFENSE DEFINITION OF CASE MANAGEMENT

TRICARE Prime

TRICARE Extra

TRICARE Standard

CHAMPVA

Beneficiary Counseling and Assistance Coordinators (BCACs)

CAC

DBN

DoD ID

COMMON DENIALS FOR TRICARE

TRICARE Appeals

Common Reasons for a TRICARE claim review

Which charges are denied through TRICARE

What should be included on the TRICARE appeal

RBRVS/RVU Concepts

RVU

GAF (GPCI)

Status Codes

Status Code A

Status Code B

Status Code C

Status Code E

Status Code I

Status Code M

Status Code N

Status Code P

Status Code Q

Status Code R

Status Code T

Status Code X

PC/TC Indicator

PC/TC Indicator 0

PC/TC Indicator 1

PC/TC Indicator 2

PC/TC Indicator 3

PC/TC Indicator 4

PC/TC Indicator 5

PC/TC Indicator 6

PC/TC Indicator 7

PC/TC Indicator 8

PC/TC Indicator 9

Global Surgery Indicators

Global Surgery Indicators 000

Global Surgery Indicators 010

Global Surgery Indicators 090

Global Surgery Indicators MMM

Global Surgery Indicators XXX

Global Surgery Indicators YYY

Global Surgery Indicators ZZZ

Three fields following the global surgery days field breakdown

Multiple procedure

Multiple procedure 0

Multiple procedure 1

Multiple procedure 2

DEERS

DoD Benefits Number (DBN)

DoD ID number

Two types of TRICARE providers

Multiple procedure 3

Multiple Procedure 4

Multiple Procedure 5

Multiple Procedure

The Clinical Prior
Authorization Program

Multiple Procedure 6

Multiple Procedure 7

Technical Component 9

Bilateral surgery

Bilateral surgery 0

Medigap

Bilateral surgery 1

Bilateral surgery 2

Bilateral surgery 3

Bilateral surgery 9

Assistant at Surgery

Assistant at Surgery 0

Assistant at Surgery 1

Assistant at Surgery 2

Assistant at Surgery 9

Co-surgeons

Co-surgeons 0

Co-surgeons 1

Co-surgeons 2

Co-surgeons 9

Team Surgery

Team surgeons 0

Team surgeons 1

Team surgeons 2

Team surgeons 9

Endoscopic base code field

Accept Assignment

Advance Beneficiary Notice

Civilian Health and Medical Program of tf the Department of Veteran Affairs
CHAMPVA

Crossover Claim

Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

Medigap

National Provider Identifier (NPI)

Non-Participating Provider

Participating Provider

Relative Value Unit

Resourced Based Relative Value System

TRICARE

Medicare Eligibility

Medicare Parts

Medicare -- Contractual Options