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Claims
Different kinds of claims
Question | Answer |
---|---|
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 |