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CMS-1500 Claim

Essential Claim Instructions

TermDefinition
billing entity legal business name of the provider's practice
diagnosis pointer used to describe relationships between submitted diagnosis and service line treatment information on health claims and encounters. They indicate the reason the service was performed.
National Plan and Provider Enumeration System (NPPES) developed by CMS to assign unique identifiers to health care providers (NPI) and health plans (HPID)
optical character reader (OCR) device used for optical character recognition
optical scanning uses a device (e.g. scanner) to convert printed or hand written characters into text that can be viewed by an optical character reader.
supervising physician a licensed physician in good standing who, according to state regulations, engages in the direct supervision of nurse practitioners and/or physician assistants whose duties are encompassed by the supervising physician's scope of practice.
supplemental plan covers the deductible and copay or coinsurance of a primary health insurance policy
National Provider Identifier (NPI) unique identifier to be assigned to health care providers as an 8- or possibly 10-character alphanumeric identifier, including a check digit in the last position.
check digit one-digit character, alphabetic or numeric, used to verify the validity of a unique identfier
global fee (global surgery package) charges are bundled into one charge covering presurgical evaluation and management, initial and subsequent hospital visits, surgical procedure, the discharge visit, and uncomplicated postoperative follow-up care in surgical office.
direct admission physician refers a patient to the hospital for observation, bypassing the clinic or emergency department
preoperative before surgery
postoperative after surgery
observation services clinically appropriate services including; ongoing short-term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged.
Created by: tina.reynolds