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Wisconsin Department of Health and Family Services Income Maintenance Quality Assurance Second Party Review Manual Release 08-02 April 3, 2008 |
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Wisconsin Department of Health and Family Services Income Maintenance Quality Assurance Second Party Review Manual Release 08-02 April 3, 2008 |
Policy References
MEH-EBD 24.7 Meeting the Deductible
BC+ 17.4 Meeting the Deductible
Note: All expenses used to meet the deductible must be verified. See BC+9.9.4 Medical Expenses , MEH-EBD 20.3.6 Medical Expenses
Field Descriptions
Name:
Name of individual meeting Healthcare eligibility requirements with a met deductible.
Source/Provider:
Name of the provider or entity that is billing the individual in #1 for goods or services used to meet the deductible.
Service/Payment Date:
Date the goods or services were rendered or the date payment was made for the goods or services.
Total Liability:
The dollar amount the individual in #1 is responsible to pay to the source/provider. The client's liability amount equals the total bill amount minus any Third Party Liability amount. This is the amount which is applied towards the deductible. This is a currency value.
Total Bill Amount
This field displays the total bill prior to any Third Party Liability. This may not be the amount to applied toward the deductible. See Total Liability for the amount applied toward the deductible.
Meet Countable Criteria?:
After reviewing the expenses listed to meet the deductible, determine whether the expense meets countable criteria as outlined in policy and enter your response in this field. Select Yes or No.
Yes = The expense displayed meets the countable criteria.
No = The expense displayed did not meet countable criteria.
Total
The total dollar amount of all bills that may be applied toward a deductible.
Discrepancy:
If there were any expenses not meeting countable criteria, select a discrepancy from the drop down list provided. If more than one expense does not meet the countable criteria, select a discrepancy which corresponds to the expense error resulting in the greatest financial impact on the case.
This page last updated in Release Number: 08-01
Release Date: 03/03/08
Effective Date: 02/01/08
