When a patient is covered by Strongbow Insurance and behavioral health claims should automatically go to Red Oak, what configuration is used?

Study for the RHB330 Resolute Hospital Billing Claim and Remittance Test with questions, hints, and explanations. Enhance your billing skills and excel in your exam!

This item tests how you route claims to an alternate payer when a different payer handles a subset of services. When a patient is covered by Strongbow Insurance but behavioral health claims should go to Red Oak, you use an Alternate Payer configuration. This setup designates that for specific service categories (like behavioral health), the claim should be submitted to a payer other than the primary one. With the alternate payer mapping in place, those behavioral health claims automatically route to Red Oak, while other claims can continue to bill Strongbow as the primary payer. Remittance Routing would handle where payment notices go, not which payer the claim is sent to; Eligibility Override changes eligibility checks, not routing logic; and Primary Payer would direct all claims to the main payer, which wouldn’t achieve the desired split routing.