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The HIPAA mandated electronic transaction for claims is known as the HIPAA claim, the 837 claim, and the
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What organization determines the content of both the HIPAA 837 and the CMS 1500 claims?
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GuntermanINS Ch 8
Healthcare claim preparation and transmission
| Question | Answer |
|---|---|
| The HIPAA mandated electronic transaction for claims is known as the HIPAA claim, the 837 claim, and the | HIPAA X12 837 Health Care Claim or Equivalent Encounter Informaiton |
| What organization determines the content of both the HIPAA 837 and the CMS 1500 claims? | NUCC |
| Where is the carrier block located on the CMS 1500 form? | upper right |
| The CMS 1500 form has what information included in the patient information section | they type of insurance, patient's relationship to the insured, authorized person's signature. |
| A billing service that is sending a claim is likely to be the | billing privider |
| A physician practice that uses a billing service to send its claims is | pay-to-provider |
| The provider who provides the procedure on a claim if other than the pay-to provider is called | rendering provider |
| If 3 providers are indicated for a claim for lab services. The clearinghouse is the billing provider, what would the physician and the laboratory be? | physician is the pay-to and the laboratory is the rendering. |
| The rendering provider is the | physician who actually provides the service |
| A legacy ID number has two parts, the number itself as well as a | qualifier |
| Section 24 on the CMS 1500 form records service line information that contains what? | procedures performed for the patient |
| A data element that HIPAA always mandates reporting is called | required data element |
| A data element that HIPAA mandates reporting under certain conditions is called | situational data element |
| When the patient and the insured are no the same person, what type of code is required to indicate this fact | individual relationship code |
| An individual relationship code indicates what | the patient's relationship to the insured |
| ON a HIPAA claim, a claim control number and the line item control number can be assigned to the claim by whom | the sender |
| Payers are identified by what? | National Payer ID |
| Correct medical code sets for claims are those that are | valid at the time the service was provided |
| Correct administrative code sets for claims are those that are | valid at the time the claim was prepared |
| What is a claim attachment | additional data sent to support a claim |
| A claim that has been received with no errors and accepted for adjudications by the payer is a | clean claims |
| How many major methods are there for transmitting claims electronically | three |
| The method of transmitting claims in which providers and payers exchange transactions directly without using a clearinghouse is called | direct transmission to the payer |
| NPI stands for | National Provider Identifier |
| The Primary Provider identifier is known as | NPI |
| NUCC stands for | National Uniform Claim Committee |
| Who mandates the use of the NPI on claims | HIPAA |
| The HIPAA 837P or the CMS 1500 paper claim is in use for what | report physicians' services |
| Who mandates HIPAA claims from most providers | CMS |
| Who decides what information is required on claims | The National Uniform Claim Committee |
| What type of claims are usually created using a patient billing program, printed and then mailed to the payer? | A paper claim |
| When completing claims, choosing self as the patient's relationship means that the insured is | the patient |
| How many digits are used to report a patient's birth dates on HIPAA claims | eight |
| The referring provider is the physician who | sends a patient to another provider |
| POS stands for | Place of service |
| What is a taxonomy code | administrative codes set for identifying a physician's specialty |
| A taxonomy code consists of | a ten character alphanumeric code |
| the term outside lab means | off the premises of the ordering physician. |
| A non-NPI ID number has 2 parts, these parts are | the qualifier code and the number |
| A diagnosis pointer indicates what | which procedure code and which diagnosis codes are connected to that date of service |
| In the 837 P for the HIPAA electronic claim, what does "P" stand for? | Professional |
| A responsible party is a person, other than the insured, who | assumes the payment of the patient's bill |
| The term subscriber also means | the insured |
| HIPAA claims have how many major sections? | 5 |
| What are the 5 major sections of a HIPAA claim | provider, subscriber, payer, details, and services |
| A claim resaon submission code is also known as | A claim frequency code |
| The line item control number or the claim contraol number on a HIPAA claims is assigned by who | the biller |
| A software that checks claims for errors before they are sent is known as a | claim scrubber |
| The three major methods of claim transmission is direct, direct, data, entry online, and | clearinghouse |
| the person or organization that will be paid for the services on a HIPAA claim | pay-to provider |
| the person or organization sending a HIPAA claim | billing provider |
Created by:
monicagunterman