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P &I Claims

QuestionAnswer
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