Blocks 1 through 13
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Block 1 | Type of Insurance
🗑
|
||||
| Block 1 a | Insured's ID Number
🗑
|
||||
| Block 2 | Patients Name
🗑
|
||||
| Block 3 | Patient's Birth Date and Sex
🗑
|
||||
| Block 4 | Insured's Name
🗑
|
||||
| Block 5 | Patients Address
🗑
|
||||
| Block 6 | Patients relationship to Insured
🗑
|
||||
| Block 7 | Insured's Address
🗑
|
||||
| Block 8 | Reserved for NUCC use 8
🗑
|
||||
| Block 9 | Medigap
🗑
|
||||
| Block 9 a | Other insured's Policy, Group Number (Medigap)
🗑
|
||||
| Block 9 b | Reserved for NUCC 9b Leave Blank
🗑
|
||||
| Block 9 c | Reserved for NUCC 9c Leave Blank
🗑
|
||||
| Block 9 d | Insurance Plan Name (Medigap)
🗑
|
||||
| Block 10 a,b,c | Is patients condition related to, A employment, B auto accident, C other accident
🗑
|
||||
| Block 11 | Insured's policy group or FECA number
🗑
|
||||
| Block 11 a | Insured's Date of birth, Sex
🗑
|
||||
| Block 11 b | Other Claim ID Designated by NUCC
Blank 11b
🗑
|
||||
| Block 11 c | Insurance Plan Name
🗑
|
||||
| Block 11 d | IS THERE ANOTHER HEALTH BENEFIT PLAN . QUESTION ?????
🗑
|
||||
| Block 12 | Patients or Authorized person's signature. Authorize the release of any Medical or other information necessary to process this claim.
🗑
|
||||
| Block 13 AOB- Assignment of Benefits | Insured's or Authorized person's signature. Authorizes payments of medical benefits to the undersigned physician or supplier for services described below.
🗑
|
||||
| Block 10 d | Claim Codes Designated By NUCC 10 d Leave Blank
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Leiannlg
Popular Medical sets