USHAI 061P Case Closure for Utah State Hospital Insurance and Adult Patient Cases
In order to close an Office of Recovery Services/Utah State Hospital (ORS/USH) case, the case must meet at least one of the closure criteria listed below.
1. PIF - Paid In Full. Arrearages are zero by payment in full or by a negotiated settlement amount.
2. NOB – No Obligation.
a. The patient is assessed with a zero obligation.
b. The patient is considered indigent. Complete the “Checklist to Determine if the Patient is Indigent” (form SHPI). Close the case if any of the following apply:
i. The patient is presently, or prior to being admitted, was determined to be eligible for Medicaid.
ii. The patient is/was active on the following public assistance programs: AM, BM, DM, EM, FM, FS, GF, NH, QMB, OTHER.
iii. Patient was admitted as an Acute Care Admittance (also known as ARTC Adult Recovery Treatment).
iv. An assessment is completed to determine the patient’s and/or spouse’s ability to pay toward the USH costs and it is determined that the patient and/or spouse has no ability to pay toward the hospital costs.
3. DENY – Claim Denied (insurance cases only). The insurance company denied the claim.
4. DYFU – Claim Denied with Follow-up (insurance cases only). The insurance company denied the claim after ORS and/or the USH has followed up or disputed a denial.
5. NINS – No Insurance (Insurance Cases only). An insurance case was opened and later it was determined the patient was not or never covered by insurance.