P &I Claims
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| The patient and/or insured authorizes the payer to reimburse the provider directly | Assignment of benefits
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| The provider agrees to accept what the insurance company allows or approves as payment in full for the claim | Accept assignment
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| Person responisble for paying the charges | Gurantor
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| Contracts with a health insurance plan and accepts whatever the plan pays for procedures of service performed | Participating provider
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| The finacial record source document used by healthcare providers and other peronnel to record treated diagnoses and services rendered to the patient during the current encounter | Encounter form
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| The encounter form in a physicians office | superbill
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| The encounter form in a hospital | chargemaster
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| A permanent record of all finacial transactions between the provider and the patient | patient ledger
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| the electronic or manual transmission of claims data to payers or clearinghouses for processing | claims submission
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| Contains all required data elements needed to process and pay the claim | clean claim
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| a provision of group health insurance policies intended to keep multiple insurers form paying benefits covered by other policies | coordination of benefits
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| the claim is compared to payer edits and the patients health plan benefits to verify | Claims adjudication
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| A remiottance advice submitted to the provider electonically is called _______. | electronic remittance advice
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| what medicare calls the remittance advice | PRN Provider remittance notice
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| the payer deposits funds to the providers account | electronic fund transfer
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| assigning lower level codes then documented in the record | downcoding
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| submitting multiple cpt codes when just one code should have been submitted. | unbundling
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| A permanent record of all finacial transactions between the provider and the patient | patient ledger
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| the electronic or manual transmission of claims data to payers or clearinghouses for processing | claims submission
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| Contains all required data elements needed to process and pay the claim | clean claim
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| a provision of group health insurance policies intended to keep multiple insurers form paying benefits covered by other policies | coordination of benefits
🗑
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| the claim is compared to payer edits and the patients health plan benefits to verify | Claims adjudication
🗑
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| A remiottance advice submitted to the provider electonically is called _______. | electronic remittance advice
🗑
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| what medicare calls the remittance advice | PRN Provider remittance notice
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| the payer deposits funds to the providers account | electronic fund transfer
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| assigning lower level codes then documented in the record | downcoding
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| submitting multiple cpt codes when just one code should have been submitted. | unbundling
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Created by:
tlindrose
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