Patient Name(Required) First Last Is there a secondary insurance listed on the patient's intake or a secondary insurance card scanned into eDocs?(Required) No Secondary Insurance Listed or Scanned Yes, a Secondary was listed. Double Check that there is not a secondary insurance listed on the intake and/or scanned in eDocs that we should have filed their claims with. Was the secondary insurance filed? Yes No Is there anything that would suggest this is an MVA or has a lawyer involved? Yes No 1. Look at the patient's intake to see if they checked a lawyer is involved. | 2. Look at eDocs to see if any lawyers have requested medical records. | 3. Look at the Medical Record Request page on Quip (in process and completed) to see if the a lawyer has requested medical records. | DO NOT SEND ANY CASED INVOLVING A LAWYER TO FRANKLIN COLLECTIONS. Was the patient sent at least two letters 60 and/or 90 Day Past Due informing them that they may be transferred to collections?(Required) Yes No Look at Account Notes to confirm.Was the patient called and informed of their past due account at least twice?(Required) Yes No Look at Account Notes to confirm.Charge Amount(Required)Insurance Pmt Amount(Required)Insurance Adj Amt(Required)Insurance Balance(Required)Allowable AmountPatient Charge Amount(Required)Patient Pmt Amount(Required)Patient Adj Amount(Required)Patient Balance(Required)% Outstding of Allowed% Collected of Allowed% Allowed of Charged% Collected of ChargedOverride Franklin Collection(Required) Yes No Comments:Insurance Balance Must Be $0 before patient's account is sent to collections Leave Patient on 120 Report and transfer to Collections once Insurance Balance is $0 All insurance claims must be filed prior to transferring a patient to collections. Add secondary insurance. Transfer balance to secondary insurance, file claims with secondary insurance and make a Patient Account Note. Leave Patient on 120 Report and transfer to Collections once Insurance Balance is $0 Patient should receive at least two phone calls and two letters before being transferred to collections. Leave Patient on 120 Report and transfer to Collections once they have received at least two letters and two calls. Transfer to Franklin Collections Follow Set Protocol: 1. Send Franklin Collection Transfer Form | 2. Web PT EMR Face Sheet | 3. Latest Statement Set Patient Account to Collection in Web PT Billing, Set Patient Account to Collection in Web PT EMR Transfer to In House Collections Mark as in Collections in Web PT EMR and mark as In Collections in Web PT Billing. Make a case note in Web PT Billing the patient is in In House Collections
