Birthday Rule Medicare Payer Age Introduce DOB AGB Medicare Part A MOON CSN Room Coverage Deductible Guarantor Ineligible RCO Thank You HAR Active Deposit Patient Class HIPAA Benefits TPL Pull Method Medicare Part C ABN SSN Name DOB SSN HAR Access $1,340 Address Check- in Duration Medicaid Reviewed by pt for accurate info Payment Referral 06 11 Pre- Admit Pending Check- out 501r MSPQ Copay People 65 or older Disabled ESRD Fin Resp for Non- Covered 05 Confine Financial Responsibility Form BCBS Encounter COB Patient RUBA Birthday Rule Medicare Payer Age Introduce DOB AGB Medicare Part A MOON CSN Room Coverage Deductible Guarantor Ineligible RCO Thank You HAR Active Deposit Patient Class HIPAA Benefits TPL Pull Method Medicare Part C ABN SSN Name DOB SSN HAR Access $1,340 Address Check- in Duration Medicaid Reviewed by pt for accurate info Payment Referral 06 11 Pre- Admit Pending Check- out 501r MSPQ Copay People 65 or older Disabled ESRD Fin Resp for Non- Covered 05 Confine Financial Responsibility Form BCBS Encounter COB Patient RUBA
(Print)
Birthday Rule
Medicare
Payer
Age
Introduce
DOB
AGB
Medicare Part A
MOON
CSN
Room
Coverage
Deductible
Guarantor
Ineligible
RCO
Thank You
HAR
Active
Deposit
Patient Class
HIPAA
Benefits
TPL
Pull Method
Medicare Part C
ABN
SSN
Name
DOB
SSN
HAR
Access
$1,340
Address
Check-in
Duration
Medicaid
Reviewed by pt for accurate info
Payment
Referral
06
11
Pre-Admit
Pending
Check-out
501r
MSPQ
Copay
People 65 or older
Disabled
ESRD
Fin Resp for Non-Covered
05
Confine
Financial Responsibility Form
BCBS
Encounter
COB
Patient
RUBA
