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4040 week one1


Clean Claim A complete insurance claim form submitted withinthe program time limit that contains all the necessary info with out deficiencies so that it can be processed and paid promptly
Deleted Claim Insurance claim that has been canceled, deleted, or voided by a medicare fiscal intermediary
Dirty Claim A claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment
Incomplete Claim Any medicare claim missing necessary info; such are identified to the provider so that they may be resubmitted
Invalid Claim Any claim that contains complete, necessary info but is illogical or incorrect
Other Claim Medicare claims not considered "clean" claims that require investigating or development on a prepayment basis
Paper Claim An insurance claim submitted on paper includes those optically scanned and converted to an electronic form by the insurance carrier
Pending Claim An insurance claim held in suspense because of review or other reason by the third party payer
Physically Clean Claim Insurance claims with no staples or highlighted areas & the bar code area has not been deformed
Rejected Claim An insurance claim has not been processed or cannot be processed due to incorrect or missing information
Health Insurance Claim Form Known as CMS-1500 a universal insurance claim form
Durable Medical Equipment Any medical equipment used in the home to aid in a better quality of living. It is a benefit included in most insurances
Electronic Claim An insurance claim submitted to insurance carrier via dial up modern direct data entry or over the internet by the way of digital subscriber line
National Provider Identifier A Medicare 10 digit number issued to providers which is retained for a lifetime
Optical Character Recognition A device that can read typed characters at very high speed and convert them to digitized files that can be saved on disk
Closed fracture a fracture where the integrity of the over lining muscle and skin has not been breached
Myocardial Infarction a sudden inadequate flow of blood to the heart
Open Fracture a wound resulting in direct contact of the bone and tissue with the environment
Lacerations an open wound produced by tearing of body tissue
Social Security Number An individuals tax identification number issued by the federal government
FTP File transfer protocol
EMC Electronic Medical Claim
AIDS Acquired Immunodeficiency Syndrome
OCR Optical character recognition
MSP Medicare secondary payer
MCD Medicaid
MQMB Medicaid qualified Medicare beneficiary
SCHIP State Children's health insurance program
MCHP Maternal and child health program
MN Medically Needy
EPSDT Early periodic screening diagnosis and treatment
AHCCCS Arizona health cost containment system
DEFRA Deficit reduction action
CHAP Child health assurance program
QI Qualifying individuals program
Created by: veronica.butler