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Claims

Different kinds of claims

QuestionAnswer
The standard paper claim form used by health care professionals and suppliers to bill insurance carriers for services provided to patients. The CMS-1500
Its one that is submitted on paper and converted to electronic form by insurance companies Paper Claim
A health care claim that is transmitted electronically: also known as an electronic media claim (EMC) Electronic Claim
health insurance claim form that has been completed correctly without any errors or omissions and was submitted within the program or policy time limit Clean Claim
has no staples or highlighted areas and on which the bar code area has not been deformed Physically Clean Claim
has not been processed or cannot be processed or various reasons Rejected Claim
is held in suspense for review or other reason by the third-party payer Pending Claim
Any Medicare claim missing required information Incomplete Claim
Medicare claim that contains complete, necessary information but is illogical or incorrect Invalid Claim
submitted with errors, requiring manual processing for resolution, or rejected for payment Dirty Claim
A claim canceled, deleted, or voided by a Medicare Fiscal Intermediary Deleted Claim
Requires Medicare administrative contractors to pay the prompt payment interest rate on all clean claims not paid in a timely manner Omnibus Budget Reconciliation Act (OBRA)
Is sent when requesting a review of a denied claim Cover Letter
Created by: Leiannlg
 

 



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