Introduction to EFS

What is EFS' main function and what are the teams in the EFS group?

Billing, SARs and UR Nurses

To find a pay source for our uninsured patients, Intake and Follow up

Special projects, Coders and registrars

What are the 4 HMOs?

HPN, Culinary, Cigna, United Healthcare

Anthem BCBS, UMR, Kaiser, HPN

Silver Summit, HPN, United Healthcare, UMR

Anthem BCBS, Silver Summit, HPN, Molina

What program does a legal permanent resident less than 5 years qualify for?

HMO

FFS Medicaid

Emergency Medicaid (EMO)

HPN

Do clients with an active Visa qualify for Medicaid or EMO?

Yes

What is the income guideline for a single childless adult?

$1483

$1064

$2180

$1755

1563

When should you manipulate the effective date in the FPL screen?

For EMO cases

If you request prior medical

For HMO cases only

For Medicaid FFS cases only

When do you manipulate the expiration date under the FPL screen?

For EMO cases

If you request prior medical

For HMO cases only

For Medicaid FFS cases only

Is annual leave income counted to determine eligibility for a house hold when requesting prior medical if received in the month of service?

Yes

Whos household is an unborn child counted for?

The pregnant mother

mother and father

unborn's siblings only

Everyone

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