Save
Busy. Please wait.
Log in with Clever
or
show password
Forgot Password?
Don't have an account?  Sign up 
Sign up using Clever
or
Username is available taken
show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account. Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
focusNode
Didn't know it?
click below
 
Knew it?
click below
Don't Know
Remaining cards (0)
Know
0:00
edit
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

claims processing_2

claims processing/compliance

QuestionAnswer
Employer Identification Number (EIN) Unique identifier issued by the Internal Revenue Service (IRS) for employers as required by HIPAA Electronic Health Care Transactions and Code Sets
First Party The insured
Guarantor The party responsible for payment of services provided
HIPAA Electronic Health Care Transactions and Code Sets HIPAA standardization of electronic transactions of health care data, including data elements, standard code sets, unique health identifiers, security safeguards, and privacy standards
HIPAA National Identifiers Required identification systems for health care organizations and health care providers
HIPAA Privacy Rule HIPAA national standards that protect individuals' medical records and other personal health information; covers the use and disclosure of PHI
HIPAA Security Rule Requires health care providers to establish safeguards ensuring the protection of PHI whenever transmitting any type of patient information via electronic transmission
HIPAA X12 837 (Health Care Claim or Equivalent Encounter Information) HIPAA mandated electronic transaction standard for claims, usually called the 837 claim or the HIPPA claim
Incomplete Claim Status Claim status indicating a claim is missing required information
Insurance Carrier the company that issues and assumes the risk of an insurance policy
Invalid Claim Status Claim status indicating a claim contains complete information, but the information may be incorrect and cannot be processed by the carrier
Manual Billing CMS-1500 is completed by hand and submitted for processing
Minimum necessary The HIPAA Privacy Rule stipulates that covered entities limit the amount of information disclosed to the minimum necessary to achieve the specified goal
National Provider Identifier (NPI) Unique identifier issued by the CMS as the standard of identification for health care providers
National Uniform Claim Committee (NUCC) Led by the American Medical Association (AMA) and determines the content of CMS-1500 claim forms
Created by: tina.reynolds
Popular Health & Social Care sets

 

 



Voices

Use these flashcards to help memorize information. Look at the large card and try to recall what is on the other side. Then click the card to flip it. If you knew the answer, click the green Know box. Otherwise, click the red Don't know box.

When you've placed seven or more cards in the Don't know box, click "retry" to try those cards again.

If you've accidentally put the card in the wrong box, just click on the card to take it out of the box.

You can also use your keyboard to move the cards as follows:

If you are logged in to your account, this website will remember which cards you know and don't know so that they are in the same box the next time you log in.

When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

Pass complete!
"Know" box contains:
Time elapsed:
Retries:
restart all cards