Notes

SELF PAY
Demo Info Verified With PT()
Name of Current Health Plan: SELF PAY
Health Plan Verified Active: NA
Insurance Cards on File: NA
Experian Eligibility Reviewed for Accuracy YES
HP Effective Dates Updated Per Experian:
Collection Attempt Made: YES
Amount Collected: 0.00
Additional PA Notes: No surprise disclosure given, DOORWAY COVID PRECAUTIONS, ALL CONSENTS SIGNED VERBALLY COVID PRECAUTIONS,PT STATED UNABLE TO PAY WILL WAIT FOR THE BILL



TRICARE
Demo Info Verified With PT()
Name of Current Health Plan: Tricare Prime
Health Plan Verified Active:YES
Insurance Cards on File:NA
Experian Eligibility Reviewed for Accuracy: YES
Collection Attempt Made: YES
Amount Collected:NA
Additional PA Notes: No surprise disclosure given, DOORWAY COVID PRECAUTIONS, ALL CONSENTS SIGNED VERBALLY COVID PRECAUTIONS




DUAL COVERAGE



Demo Info Verified With PT()
Name of Current Health Plan: Medicare-Tricare For Life
Health Plan Verified Active:YES
Insurance Cards on File:NA
Experian Eligibility Reviewed for Accuracy: YES
Collection Attempt Made: DUAL COVERAGE
Amount Collected:NA
Additional PA Notes: No surprise disclosure given, DOORWAY COVID PRECAUTIONS, ALL CONSENTS SIGNED VERBALLY COVID PRECAUTIONS





MEDICARE:
Demo Info Verified With PT()
Name of Current Health Plan:MEDICARE
Health Plan Verified Active: YES
Insurance Cards on File:
Experian Eligibility Reviewed for Accuracy YES
HP Effective Dates Updated Per Experian:
Collection Attempt Made:YES
Amount Collected:$0
Required Forms Obtained (ABN, IML, SFF, etc.):
MSPQ Completed:YES
Additional PA Notes: No surprise disclosure given, DOORWAY COVID PRECAUTIONS, ALL CONSENTS SIGNED VERBALLY COVID PRECAUTIONS





MEDICAID
Demo Info Verified With PT ()
Name of Current Health Plan: MEDICAID
Health Plan Verified Active: YES
Insurance Cards on File:NA
Experian Eligibility Reviewed for Accuracy YES
Collection Attempt Made: NA
Amount Collected: 0.00
Additional PA Notes: No surprise disclosure given, DOORWAY COVID PRECAUTIONS, ALL CONSENTS SIGNED VERBALLY COVID PRECAUTIONS




COMMERICALS
Demo Info Verified With PT()
Name of Current Health Plan:
Health Plan Verified Active:YES
Insurance Cards on File:NA
Experian Eligibility Reviewed for Accuracy: NA
Collection Attempt Made: NO PAYMENT DUE AT THIS TIME
Amount Collected:$0
Additional PA Notes: No surprise disclosure given, DOORWAY COVID PRECAUTIONS, ALL CONSENTS SIGNED VERBALLY COVID PRECAUTIONS




VA
Demo Info Verified With PT()
Name of Current Health Plan: VA
Health Plan Verified Active: NA
Insurance Cards on File: NA
Experian Eligibility Reviewed for Accuracy:
HP Effective Dates Updated Per Experian: NA-OTHER RESOURCE UTILIZED
Collection Attempt Made: NO PAYMENT DUE
Amount Collected:$ 0.00
Additional PA Notes: No surprise disclosure given, DOORWAY COVID PRECAUTIONS, ALL CONSENTS SIGNED VERBALLY COVID PRECAUTIONS




WORKER'S COMP
Demo Info Verified With PT()
Name of Current Health Plan: WORKERS COMP
Health Plan Verified Active:YES
Insurance Cards on File:NA
Experian Eligibility Reviewed for Accuracy: NA
Collection Attempt Made: NO PAYMENT DUE AT THIS TIME
Amount Collected:$0
Additional PA Notes: No surprise disclosure given, DOORWAY COVID PRECAUTIONS, ALL VERBAL CONSENTS SIGNED VERBALLY COVID PRECAUTIONS






VIRTURAL BED NOTE
Admit type:INPT/OBV
Nursing unit:
Admit reason:
Admiting Doctor:
Virtual bed time:
IMM and MOON: NA