The organization responsible for claim content is abbreviated as

NUCC(national uniform claim committee)

When do you report the patient's information in Item Number 5 of the CMS-1500 claim form?

Only if it is different from the insured's information

What Item Number is used to refer to an inpatient stay and indicate the admission and discharge dates associated with the service(s) on the claim?

Item Number 18: Hospitalization Dates Related to Current Services

When resubmitting a claim, you must enter a bill frequency code aligned left in the left-hand side of the field. Which of the following would be correct bill frequency codes to place in Item Number 22?

7( replacement of prior claim) and 8(void/cancel of prior claim)

When grouping services, which of the following must be identical for that service line?

Charges, Procedure code, Place of service, Individual provider

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chapter 7

Question	Answer
The organization responsible for claim content is abbreviated as	NUCC(national uniform claim committee)
The HIPAA-mandated electronic transaction for claims from physicians and other medical professionals is the Blank______ Health Care Claim: Professional.	HIPAA X12 837
The current paper claim approved by the NUCC is called the Blank______ claim form.	CMS-1500
Under HIPAA EDI transactions must move to which format for 837P claims to provide enough room for ICD-10-CM codes and for additional data?	5010A1 version
Which Item Numbers on the CMS-1500 claim form contain information about the provider and the patient's condition, including the diagnoses, procedures, and charges?	Item Numbers 14 through 33
What committee is responsible for modifying the instructions for the CMS-1500 to bring it in more accord with the electronic claim without having to change the overall layout?	NUCC
When do you report the patient's information in Item Number 5 of the CMS-1500 claim form?	Only if it is different from the insured's information
The Blank______ provider is a provider of health services reported on a claim, usually a physician practice.	billing
The Blank______ provider is a physician or other entity, such as a lab, that has provided the care.	rendering
In Item Number 4 of the CMS-1500 claim form, you are to enter the full name of the person who Blank	holds the insurance policy
The Blank______, called the Other ID number, of the referring provider, ordering provider, or other source is the payer-assigned unique identifier of the physician or other healthcare provider.	non-NPI ID number
What Item Number is used to refer to an inpatient stay and indicate the admission and discharge dates associated with the service(s) on the claim?	Item Number 18: Hospitalization Dates Related to Current Services
______ means the code and original reference number assigned by the destination payer or receiver to indicate a previously submitted claim or encounter.	Medicaid resubmission
When resubmitting a claim, you must enter a bill frequency code aligned left in the left-hand side of the field. Which of the following would be correct bill frequency codes to place in Item Number 22?	7( replacement of prior claim) and 8(void/cancel of prior claim)
Section 24 of the claim reports the Blank______ information—that is, the procedures—performed for the patient.	service line
When grouping services, which of the following must be identical for that service line?	Charges, Procedure code, Place of service, Individual provider
The Item Number for EPSDT Family Plan refers to some services that may be covered under state Blank______ plans.	Medicaid

Created by: mwaciba

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