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4040 week one1
term
| Question | Answer |
|---|---|
| Clean Claim | A complete insurance claim form submitted withinthe program time limit that contains all the necessary info with out deficiencies so that it can be processed and paid promptly |
| Deleted Claim | Insurance claim that has been canceled, deleted, or voided by a medicare fiscal intermediary |
| Dirty Claim | A claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment |
| Incomplete Claim | Any medicare claim missing necessary info; such are identified to the provider so that they may be resubmitted |
| Invalid Claim | Any claim that contains complete, necessary info but is illogical or incorrect |
| Other Claim | Medicare claims not considered "clean" claims that require investigating or development on a prepayment basis |
| Paper Claim | An insurance claim submitted on paper includes those optically scanned and converted to an electronic form by the insurance carrier |
| Pending Claim | An insurance claim held in suspense because of review or other reason by the third party payer |
| Physically Clean Claim | Insurance claims with no staples or highlighted areas & the bar code area has not been deformed |
| Rejected Claim | An insurance claim has not been processed or cannot be processed due to incorrect or missing information |
| Health Insurance Claim Form | Known as CMS-1500 a universal insurance claim form |
| Durable Medical Equipment | Any medical equipment used in the home to aid in a better quality of living. It is a benefit included in most insurances |
| Electronic Claim | An insurance claim submitted to insurance carrier via dial up modern direct data entry or over the internet by the way of digital subscriber line |
| National Provider Identifier | A Medicare 10 digit number issued to providers which is retained for a lifetime |
| Optical Character Recognition | A device that can read typed characters at very high speed and convert them to digitized files that can be saved on disk |
| Closed fracture | a fracture where the integrity of the over lining muscle and skin has not been breached |
| Myocardial Infarction | a sudden inadequate flow of blood to the heart |
| Open Fracture | a wound resulting in direct contact of the bone and tissue with the environment |
| Lacerations | an open wound produced by tearing of body tissue |
| Social Security Number | An individuals tax identification number issued by the federal government |
| FTP | File transfer protocol |
| EMC | Electronic Medical Claim |
| AIDS | Acquired Immunodeficiency Syndrome |
| OCR | Optical character recognition |
| MSP | Medicare secondary payer |
| MCD | Medicaid |
| MQMB | Medicaid qualified Medicare beneficiary |
| SCHIP | State Children's health insurance program |
| MCHP | Maternal and child health program |
| MN | Medically Needy |
| EPSDT | Early periodic screening diagnosis and treatment |
| AHCCCS | Arizona health cost containment system |
| DEFRA | Deficit reduction action |
| CHAP | Child health assurance program |
| QI | Qualifying individuals program |
Created by:
veronica.butler
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