Case Management

USHAI 061P Case Closure for Utah State Hospital Insurance and Adult Patient Cases

03/03 Revised 03/25/03

 

Case Closure Criteria and Codes

 

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.