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Blesi8e Ch30 Terms
[MO2] Preparing insurance Claims [Tier 01]
| Term | Definition |
|---|---|
| Administrative Simplification Compliance Act (ASCA) | identifies limited situations where paper claim forms may be submitted for payment |
| carrier | the company that provides the insurance policy |
| Centers for Medicare and Medicaid Services (CMS) | the federal agency responsible for administration of several key federal health care programs |
| clearinghouse | a company that often serves as the middleman between physicians and payers for the transmission of electronic claims into the specific format required by payers |
| CMS-1500 form | a standard claim form to submit physician services for third-party payment |
| electronic claims tracking (ECT) | computer software designed for monitoring insurance claims |
| electronic data interchange (EDI) | refers to the exchange of routine business transactions from one computer to another in a standardized format |
| electronic media claims (EMC) | a flat file format used to transmit or transport claims |
| explanation of benefits (EOB) | provides information to the patient about how an insurance claim was paid on his or her behalf |
| national provider identifier (NPI) | the standard unique health identifier for health care providers |
| reimbursement | to pay back or compensate for money spent, or losses incurred |
| scrub | claim scrubbing ensures that claims are correctly coded before being sent to the insurance company which reduces denials and increases payment to the practice |
| secondary insurance | exists when a patient is covered under more than one insurance plan |
Created by:
MaesterRay
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