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 |