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
No
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
No
Whos household is an unborn child counted for?
The pregnant mother
mother and father
unborn's siblings only
Everyone
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