Refer to the patient s medical card or referral documentation to determine the appropriate coverage for each patient. The reporting should be based on the patients actual coverage as reported in the patient s record and may vary from patient to patient. Plus on our HMO list. Plus is listed rather than the Prudential Health Care Plan of California though they are both the same entity. In this case please report Prudential as the Prucare Plan Number.
Some patients have several different cards and multiple coverages.
A. Report the entity or organization that is expected to pay, or did pay, the greatest share of the bill. The IPA, with capitated contracts, is a part of the managed care environment and because the IPA has contracts with several Health Plans it may not be possible to specify an HMO by name, leaving Managed Care-Other as the most accurate choice for Type of Coverage.