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Know about submitting documentation Only send when insurance company requests it. Explain reason for attachment. Include Patient Name and I.D. number.
Know when to bill no charges Never submit a claim for services that have a NO CHARGE. These services are documented in the patient's medical and financial records.
How do paper claims get submitted? Submitted using the CMS-1500 form and mailing it to the insurance company. Now it is always computer generated,not hand typed.
How do electronic claims get submitted? Submitted directly to clearinghouse via computer by using the internet to transmit. Electronic claims never get printe to a CMS-1500
Know the agreement for elecronic claims submission For the most part Medicar and Medicaid require all providers to submit their caims electronically. There are different ways to send claims to those offices.
Know the functions of a clearinghouse Duties to separate the clais b carrier, perform software edits, on each claim to check for errors, and transmit claims electronically to the correct insurance payer.
Which provider number is used on insurance claim forms? NPI. Lifetime 10-digit number
Know about dual coverage When a patient has two private insurance policies
How many locations for diagnostic codes can be listed o the claim form? Up to 4 diagnosis codes
Netwroks Computers may be iter-connectedin a numbe of different was to exchange info
CMS-1500 Th universal form for all insurance companies
Clean Claim Has no deficiencies and has passe all electronic edits.
Incomplete Claim Has missing information which is identified to the provider so that the claim can be corrected and resubmitted.
Pending Claim A claim that has been held in suspense while it is being reviewed or waiting for additional information.
Rejected Claim Needs further clarificaton and answers to questions
Know about entering data for OCR claims OCR guidelines require that all entries inserted appear in capital letters wit no punctuation, and no comments in blocks that do not apply.
Know the two ways claims can be tranmitted electronically Carrier Direct and clearnghouse
Know where the insurance company name and address are listed on the claim form Inserted in top right corner of claim form
Know the two sections of the claim form Patient/insured information and physician/supplier information
Know about NEIC systems Provides a national network to receive, process, edit, sort, and transmt electronic caims to insurers. Allows the physician to use one version of software to communicate with different insurers.
Created by: sanzijessica