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Insurance Billing

Insurance Billing YCST Chap 7 Terms and Abbreviations

QuestionAnswer
CMS-1500 Centers for Medicare and Medicaid Services Health Insurance Claim Form
DME Durable medical equipment
DNA Does not apply
EIN Employer identification number
HHA Home or Hospice health agency
ICR Intelligent character recognition or image copy recognition
MG Medigap
MSP Medicare Secondary Payer
NOC Not otherwise classified
NPI National Provider Identifier
OCR Optical character recognition
PRO Peer review organization or professional review organization
SOF Signature on file
What is a completed insurance claim form submitted within the program time limit that contains all the necessary information without deficiences so that it can be processed and paid promptly? Clean claim
What is a claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment? Dirty claim
What is an individual's federal tax identification number issued by the IRS for income tax purposes? EIN
What is a facility's provider number to be used by the facility to bill for services, or by the performing physician to report services done at that location? Facility provider number
What is a number assigned to a group of physicians submitting insurance claims under the group name and reporting income under one name? Group NPI
What is known as the CMS-1500? Health insurance claim form
What is any Medicare claim missing necessary information? Incomplete claim
What is any Medicare claim that contains complete, necessary information but is illogical or incorrect? Invalid claim
What is a provider's lifetime 10-digit number? NPI
What is an insurance claim held in suspense because of review or other reason? Pending claim
What is an insurance claim submitted to an insurance carrier that is discarded by the system because of a technical error or because it does not follow Medicare instructions? Rejected claim
What is a number issued to a physician who has passed the state medical examination indicating his or her right to practice medicine in the state where issued? State license number
Created by: dsljulian
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