Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
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
Normal Size Small Size show me how
Claims Process_1
| Question | Answer |
|---|---|
| Adjudication | The process health plans follow to examine and determine payment |
| Audit | A review or formal examination of a provider's accounting or patient's medical records |
| Carrier Block | Data entry area located in the upper right corner of the CMS-1500 that allows for a four-line address for the payer |
| Clearinghouse | Edits and routes electronic claims to the insurance carrier for payment |
| CMS-1500 | Claim form used to submit paper claims for services and procedures rendered by physicians and other health care professionals on an outpatient basis |
| Continuity of Care | coordinating treatment and health services between patients' health care providers |
| Covered Entities | Health plans, health care clearinghouses, or health care providers that conduct health information in electronic form in connection with a transaction covered by HIPAA |
| Denied claim status | Claim status indicating a claim has been processed, but contained incorrect or incomplete information; a claim may also be denied for medical neccesity |
| Durable Medical equipment (DME) | "equipment that can withstand repeated use, is primarily and customarily used to serve a medical purpose; generally not useful to a person in absence of illness or injury; appropriate for use in the home." AKA prosthetics, orthotics, & supplies (DMEPOS). |
| Electronic billing | the process of submitting medical claims electronically to an insurance carrier for reimbursement of services rendered by a health care provider |
| Electronic data interchange (EDI) | A secure system-to-system interchange of data in a standardized format |
| Eligibility verification | Conformation that the patient is entitled to benefits by verifying the name of the insurance carrier, the effective date of active coverage, policy information, group number, copayments, & deductible; typically performed before services are rendered |
Created by:
tina.reynolds
Popular Health & Social Care sets