FSC Wizard for G-Plan Assigners
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- Alice Georgina McBride
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1 FSC Wizard for G-Plan Assigners Overview Introduction There are many tools available to help you understand how to handle specific parts of the scheduling call. In this module, we will cover many of these topics. The topics include: Objectives Contracted and Non-contracted Plans PFS Payor Database Department Specific Policies and Procedures Plans Upon completion of this lesson, you should: Understand the difference between contracted and non-contracted with the School of Medicine Know how to use the FSC Wizard G-Plan Assignment Table Prerequisites Prior to beginning this lesson, you should have completed the following classes: Advanced Workflow Scheduling (AWF) Beginner Module 1 or Scheduling Viewing and Editing Appointment Data Form (ADF) 1
2 Contracted and Non-Contracted Plans One of the key questions asked when scheduling an appointment is if the patient is covered under an insurance plan that is contracted with the School of Medicine. This question only applies to managed care plans - Indemnity/Commercial plans do not have contracts with providers. What is a contracted plan? If a managed care plan has an agreement with the School of Medicine to accept their patients based on negotiated terms, the School of Medicine has a contract with the plan. What is a non-contracted plan? Non-contracted plans are managed care plans with which the School of Medicine does not have a negotiated agreement. This means there is no contract with the School of Medicine, so it is a non-contracted plan. It is important that schedulers inform patients that some plans will not pay for any services provided outside their network. When non-contracted, Washington University School of Medicine (WUSM) providers are considered non-contracted out of network providers. Why is this an important distinction? From the patient s perspective: There is financial risk for the patient if their health plan is noncontracted. Non-contracted HMO plans or POS plans with no swing-out option have greatest risk for patient. From the School of Medicine s perspective: The School of Medicine will receive payment if it has a contract with the managed care plan. There is financial risk for the School of Medicine when the patient is in a non-contracted plan. 2
3 FSC Wizard for G-Plan Assigners The FSC Wizard is an on-line tool from Patient Financial Services. It provides information regarding the selection of FSC/Plans for insurance assignment to support employees in the PFS process. The FSC Wizard also provides the following information: G-Plan Assignment Tables Contracted payor specific information o Referrals o Pre-certifications o Laboratory information References guides o Contracted plans o Non-Contracted plans P-Plan Assignment Information (should be used by P-Plan Assigners only) Steps for using the G-Plan Table: Step 1 Know the Insurance Company name: CIGNA GHP/Health Partners Anthem Blue Cross Blue Shield Healthlink United Health Care Step 2 Know the Plan name: HMO Choice Plus PPO 3
4 Steps used to access the FSC Wizard: 1. Access the FPP Education and References Resources web site: / 2. Click 4
5 The FSC Wizard home page will display. 5
6 3. On the vertical toolbar, click 6
7 The G-Plan Assignment Table will display. This table contains: All Contracted Plans, Medicare, MO Healthnet, and Illinois Public Aid NOTE: The G-Plan table does NOT include information regarding: o Non-contracted managed care plans o Commercial/Indemnity plans G-Plan (name, number, and mnemonic) to be assigned A link to the full page of information for each plan o Click the link to access the full page of information 7
8 4. Click the link to access the full page of information The Full Page of Information includes payor specific information including: o o o o Referral requirements Pre-certification requirements Laboratory information Copies of insurance cards 8
9 Lesson Summary In this lesson, you learned: The difference between contracted and non-contracted with the School of Medicine How to use the FSC Wizard G-Plan Assignment Table 9
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