Healthcare Claim Preparation and Transmission
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| 5010A1 version | Under HIPAA, the newest format for EDI transactions to accommodate ICD-10-CM codes and additional data.
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| administrative code set | Under HIPAA, required codes for various data elements, such as taxonomy codes and place of service (POS) codes.
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| billing provider | The person or organization (often a clearinghouse or billing service) sending a HIPAA claim, as distinct from the pay-to provider who receives payment.
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| carrier block | Data entry area located in the upper right of the CMS-1500 that allows for a four-line address for the payer.
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| claim attachment | Documentation that a provider sends to a payer in support of a healthcare claim.
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| claim control number | Unique number assigned to a healthcare claim by the sender.
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| claim filing indicator code | Administrative code used to identify the type of health plan.
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| claim frequency code (claim submission reason code) | Administrative code that identifies the claim as original, replacement, or void/cancel action.
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| claim scrubber | Software that checks claims to permit error correction for clean claims.
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| clean claim | A claim that is accepted by a health plan for adjudication.
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| CMS-1500 | Paper claim for physician services.
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| CMS-1500 (02/12) | Current paper claim approved by the NUCC.
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| condition code | Two-digit numeric or alphanumeric code used to report a special condition or unique circumstance about a claim; reported in Item Number 10d on the CMS-1500 claim form.
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| data element | The smallest unit of information in a HIPAA transaction.
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| destination payer | In HIPAA claims, the health plan receiving the claim.
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| Healthcare Provider Taxonomy Code (HPTC) | Administrative code set used to report a physician’s specialty.
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| HIPAA X12 837 Health Care Claim: Professional (837P) | The form used to send a claim for physician services to both primary and secondary payers.
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| HIPAA X12 276/277 Health Care Claim Status Inquiry/Response (HIPAA 276/277) | The standard electronic transaction to obtain information on the status of a claim.
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| individual relationship code | Administrative code that specifies the patient’s relationship to the subscriber (insured).
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| line item control number | On a HIPAA claim, the unique number assigned by the sender to each service line item reported.
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| National Uniform Claim Committee (NUCC) | Organization responsible for the content of healthcare claims.
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| other ID number | Additional provider identification number supplied on a healthcare claim.
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| outside laboratory | Purchased laboratory services.
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| pay-to provider | The person or organization that is to receive payment for services reported on a HIPAA claim; may be the same as or different from the billing provider.
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| place of service (POS) code | HIPAA administrative code that indicates where medical services were provided.
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| qualifier | Two-digit code for a type of provider identification number other than the National Provider Identifier (NPI).
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| rendering provider | Term used to identify the physician or other medical professional who provides the procedure reported on a healthcare claim if other than the pay-to provider.
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| required data element | Information that must be supplied on an electronic claim.
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| responsible party | Person or entity other than the insured or the patient who will pay a patient’s charges.
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| service line information | On a HIPAA claim, information about the services being reported.
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| situational data element | Information that must be supplied on a claim when certain other data elements are provided.
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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.
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Created by:
verbre5173