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P &I Claims
| Question | Answer |
|---|---|
| The patient and/or insured authorizes the payer to reimburse the provider directly | Assignment of benefits |
| The provider agrees to accept what the insurance company allows or approves as payment in full for the claim | Accept assignment |
| Person responisble for paying the charges | Gurantor |
| Contracts with a health insurance plan and accepts whatever the plan pays for procedures of service performed | Participating provider |
| The finacial record source document used by healthcare providers and other peronnel to record treated diagnoses and services rendered to the patient during the current encounter | Encounter form |
| The encounter form in a physicians office | superbill |
| The encounter form in a hospital | chargemaster |
| A permanent record of all finacial transactions between the provider and the patient | patient ledger |
| the electronic or manual transmission of claims data to payers or clearinghouses for processing | claims submission |
| Contains all required data elements needed to process and pay the claim | clean claim |
| a provision of group health insurance policies intended to keep multiple insurers form paying benefits covered by other policies | coordination of benefits |
| the claim is compared to payer edits and the patients health plan benefits to verify | Claims adjudication |
| A remiottance advice submitted to the provider electonically is called _______. | electronic remittance advice |
| what medicare calls the remittance advice | PRN Provider remittance notice |
| the payer deposits funds to the providers account | electronic fund transfer |
| assigning lower level codes then documented in the record | downcoding |
| submitting multiple cpt codes when just one code should have been submitted. | unbundling |
| A permanent record of all finacial transactions between the provider and the patient | patient ledger |
| the electronic or manual transmission of claims data to payers or clearinghouses for processing | claims submission |
| Contains all required data elements needed to process and pay the claim | clean claim |
| a provision of group health insurance policies intended to keep multiple insurers form paying benefits covered by other policies | coordination of benefits |
| the claim is compared to payer edits and the patients health plan benefits to verify | Claims adjudication |
| A remiottance advice submitted to the provider electonically is called _______. | electronic remittance advice |
| what medicare calls the remittance advice | PRN Provider remittance notice |
| the payer deposits funds to the providers account | electronic fund transfer |
| assigning lower level codes then documented in the record | downcoding |
| submitting multiple cpt codes when just one code should have been submitted. | unbundling |
Created by:
tlindrose
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