<p> PIEDMONT ACCESS TO HEALTH SERVICES, INC.</p><p>Policy Number: 01-11-008 SUBJECT: Presentation of Insurance Cards (DENTAL)</p><p>EFFECTIVE DATE: 04/01/2004 REVIEWED/REVISED: 04/24/2006, 07/24/2006, 03/03/2009, 03/30/2010, 02/07/2011, 01/5/2012 03/11/2013, 07/09/2014, 09/28/2015 ______</p><p>POLICY: In order to accurately file insurance claims in a timely manner, it is mandatory that patients present a valid, current insurance card each time they present to a PATHS facility seeking care.</p><p>PROCEDURE:</p><p>1. The front desk staff who greets the patient is responsible for requesting insurance information at point of the patient’s first contact upon each visit.</p><p>2. When a patient arrives at the office seeking services, the front desk staff is responsible for verifying the information on the card against what has been previously entered in to PATHS’ EHR system. The front desk staff will also scan a copy of the card into the EHR system for future reference.</p><p>3. If a patient presents with conflicting, or out of date insurance cards, the front desk staff will provide assistance in contacting the appropriate insurance company to correct any errors/omissions.</p><p>4. If a patient presents for services and does not have a valid insurance card with them, the patient will be treated as private pay and placed on a sliding fee schedule as appropriate (see PATHS’ Policy on “Patients Applying for Sliding Fee Status”).</p><p>5. If a patient refuses to accept payment responsibility for the visit, the visit will be rescheduled for a time when the patient feels they will have a valid insurance card available. However, in the case of an emergency or where delaying treatment could be detrimental to the patient’s welfare, the patient will be seen and held accountable for the financial responsibility for the services rendered, regardless of whether or not they agree with this policy.</p><p>SIGNATURES:</p><p>______/ ___ /______Chief Executive Officer Date</p><p>______/ ___ /______Chief Operating Officer Date</p><p>______/ ___ /______Chief Financial Officer Date 01-11-008 Presentation of Insurance Cards (Dental) Page 1 of 1</p>