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Health Insurance
Health Insurance Claim Form
| Term | Definition |
|---|---|
| OCR | optical character recognition |
| A claim filed without any errors or omissions is called a_____ claim | clean |
| The place of service code for a physician's office is_____ | 11 |
| NPI | national provider identifier (a lifetime number consisting of 10 digits that Medicare used to replace the Provider Identification Number and the Unique Provider Identification Number in effect 05/2008) |
| The current CMS-1500 form used for filing claims was revised in _____ of ______ | August: 2005 |
| _____ of _______ means that the PT has authorized the payment of benefits directly to the provider | assignment of benefits |
| SOF | signature on file |
| Block 24E claim form refers back to the reference number____ codes listed in block 21 | diagnosis |
| The PT account number must be noted on the CMS-1500 claim form? | False |
| Are ICD-9-CM codes needed on the CMS-1500? | Yes |
| Audit | process done prior to claim submission to examine claims for accuracy and completeness. Can be performed manually or electronically |
| audit trail | the path left by a transaction when it has been completed |
| clean claims | insurance claim forms that have been completed correctly (no errors or omissions) and can be processed and paid promptly if they meet the restrictions on covered services and blocks |
| clearinghouse | a centralized facility to which insurance claims are transmitted. Clearinghouses separate, check, and redistribute claims electronically to various insurance carriers and may offer additional services to the physician. aka third party administrators TPAs |
| direct billing | a method of electronic claims submission that uses computer software to allow a provider to an insurance carrier for payment |
| dirty claims | claims that contain errors or omissions; such claims must be corrected and reimbursed to an insurance carrier to obtain reimbursement |
| electronic claims | claims that are submitted to insurance processing facilities using a computerized medium, such as direct data entry, direct wire, dial-in telephone digital fax, or personal computer download or upload |
| electronic data interchange (EDI) | the transfer of data back and forth between 2 or more entities using an electronic medium |
| electronic (or digital) signature | a scanned signature or other such mark that is accepted as proof of approval of and/or responsibility for the content of an electronic document |
| employer identification number EIN | the number used by the IRS that identifies a business or individual functioning as a business entity for income tax reporting |
| incomplete claim | a claim that is missing information and is returned to the provider for correction and resubmission aka invalid claim |
| intelligent character recognition ICR | the electronic scanning of printed blocks as images and the use of special software to recognize these images (or characters) as ASCII text for uploading into a computer database |
| National provider identifier NPI | a lifetime number consisting of 10 digits that Medicare used to replace the Provider Identification Number and the Unique Provider Identification Number. CMS adopted NPI FULLY IN 05/2008 |
| paper (hard copy) claims | Insurance claims that have been completed manually, on paper, and sent by surface mail |
| provider | any company, individual, or group that provides medical, diagnostic, or treatment services to a PT |
| Provider identification number PIN | numbers assigned to providers by a carrier for use in the submission of claims |
| rejected claims | claims returned unpaid to the provider for clarification of any question; these claims must be corrected before resubmission |
| unique provider identification number UPIN | A number assigned by fiscal intermediaries to identify providers on claims for services |
| universal claim form | the from developed by the Health Care Financing Administration(HCFA now CMS) and approved by the American Medical Association(AMA) for use in submitting all government-sponsored claims aka CMS-1500 Health Insurance Claim Form |
Created by:
Kmart416