Busy. Please wait.
Log in with Clever
or

show password
Forgot Password?

Don't have an account?  Sign up 
Sign up using Clever
or

Username is available taken
show password

Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.


Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.

PROCESSING AN INSURANCE CLAIM-HEALTH INS BOOK

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
        Help!  

Question
Answer
show PROVIDER ACCEPTS AS PAYMENT IN FULL WHATEVER IS PAID ON THE CLAIM BY THE PAYER(EXCEPT FOR ANY COPAYMENT AND/OR COINSURANCE AMOUNTS)  
🗑
ACCOUNTS RECEIVABLE   show
🗑
show SHOWS THE STATUS (BY DATE) OF OUTSTANDING CLAIMS FROM EACH PAYER, AS WELL AS PAYMENTS DUE FROM PATIENTS  
🗑
show ASSISTS PROVIDERS IN THE COLLECTION OF APPROPRIATE REIMBURSEMENT FOR SERVICES RENDERED; INCLUDE FUNCTIONS SUCH AS INSURANCE VERIFICATION/ELIGIBILITY & PREAUTHORIZATION OF SERVICES  
🗑
ALLOWED CHARGE   show
🗑
show USE A VARIABLE-LENGTH FILE FORMAT TO PROCESS TRANSACTIONS FOR INSTITUTIONAL, PROFESSIONAL, DENTAL, AND DRUG CLAIMS  
🗑
APPEAL   show
🗑
ASSIGNMENT OF BENEFITS   show
🗑
show ACCOUNTS RECEIVABLE THAT CANNOT BE COLLECTED BY THE PROVIDER OR A COLLECTION AGENCY  
🗑
BENEFICIARY   show
🗑
show DETERMINES COVERAGE BY PRIMARY AND SECONDARY POLICIES WHEN EACH PARENT SUBSCRIBES TO A DIFFERNT HEALTH INSURANCE PLAN  
🗑
show TERM HOSPITALS USE TO DESCRIBE A PATIENT ENCOUNTER FORM  
🗑
show COMPARING A CLAIM TO PAYER EDITS AND THE PATIENT'S HEALTH PLAN BENEFITS TO VERIFY THAT THE REQUIRED INFORMATION IS AVAILABLE TO PROCESS THE CLAIM; THE CLAIM IS NOT A DUPLICATE  
🗑
CLAIMS ATTACHMENT   show
🗑
show SORTING CLAIMS UPON SUBMISSION TO COLLECT AND VERIFY INFORMATION ABOUT THE PATIENT AND PROVIDER  
🗑
show THE TRANSMISSION OF CLAIMS DATA (ELECTRONICALLY OR MANUALLY)TO PAYERS OR CLEARINGHOUSES FOR PROCESSING  
🗑
show A CORRECTLY COMPLETED STANDARDIZED CLAIM (E.G., CMS-1500 CLAIM)  
🗑
show PERFORMS CENTRALIZED CLAIMS PROCESSING FOR PROVIDERS AND HEALTH PLANS  
🗑
CLOSED CLAIM   show
🗑
COINSURANCE- COINSURANCE PAYMENT   show
🗑
show ABSTRACT OF ALL RECENT CLAIMS FILED ON EACH PATIENT  
🗑
show CONSIDERED LANDMARK LEGISLATION BECAUSE IT LAUNCHED TRUTH-IN-LENDING DISCLOSURES THAT REQ'D CREDITORS TO COMMUNICATE THE COST OF BORROWING MONEY IN A COMMON LANGUAGE SO THAT CONSUMERS COULD FIGURE OUT THE CARGES, COMPARE COSTS,SHOP FOR BEST CREDIT DEAL  
🗑
show PROVISION IN GROUP HEALTH INSURANCE POLICIES THAT PREVENTS MULTIPLE INSURERS FROM PAYING BENEFITS COVERED BY OTHER POLICIES;ALSO SPECIFIES THE COVERAGE WILL BE PROVIDED IN A SPECIFIC SEQUENCE WHEN MORE THAN ONE POLICY COVERS THE CLAIM  
🗑
show PRIVATE SECTOR HEALTH PLANS, MANAGED CARE ORGANIZATIONS, ERISA-COVERED HEALTH BENEFIT PLANS AND GOVERNMENT PLANS; ALL HEALTHCARE CLEARINGHOUSES;AND ALL HEALTHCARE PROVIDERS WHO CHOOSE TO SUBMIT OR RECEIVE TRANSACTIONS ELECTRONICALLY  
🗑
show "MANUAL DAILY ACCOUNTS RECEIVABLE JOURNAL" CHRONOLOGICAL SUMMARY OF ALL TRANSACTIONS POSTED TO INDIVIDUAL PATIENT LEDGERS/ACCOUNTS ON A SPECIFIC DAY  
🗑
show ONE THAT HAS NOT BEEN PAID WITHIN A CERTAIN TIME FRAME (E.G., 120 DAYS)  
🗑
DELINQUENT CLAIM   show
🗑
DELINQUENT CLAIM CYCLE   show
🗑
show ASSIGNING LOWER-LEVEL CODES THAN DOCUMENTED IN THE RECORD  
🗑
show SENDING DATA IN A STANDARDIZED MACHINE-READABLE FORMAT TO AN INSURANCE COMPANY VIA DISK, TELEPHONE, OR CABLE  
🗑
show COMPUTER-TO-COMPUTER EXCHANGE OF DATA BETWEEN PROVIDER AND PAYER  
🗑
show SERIES OF FIXED-LENGTH RECORDS (E.G., 25 SPACES FOR PATIENT'S NAME) SUBMITTED TO PAYERS TO BILL FOR HEALTHCARE SERVICES  
🗑
show SYSTEM BY WHICH PAYERS DEPOSIT FUNDS TO THE PROVIDER'S ACCOUNT ELECTRONICALLY  
🗑
ELECTRONIC FUNDS TRANSFER ACT   show
🗑
show ORGANIZATION THAT ACCREDITS CLEARINGHOUSES  
🗑
show ELECTRONIC FLAT FILE FORMAT  
🗑
show REMITTANCE ADVICE THAT IS SUBMITTED TO THE PROVIDER ELECTRONICALLY AND CONTAINS THE SAME INFO. AS A PAPER-BASED REMITTANCE ADVICE; PROVIDERS RECEIVE THEM MORE QUICKLY  
🗑
show FINANCIAL RECORD SOURCE DOCUMENT USED BY PROVIDERS AND OTHER PERSONNEL TO RECORD TREATED DIAGNOSES AND SERVICES RENDERED TO THE PATIENT DURING THE CURRENT ENCOUNTER  
🗑
show PROHIBITS DISCRIMINATION ON THE BASIS OF RACE, COLOR, RELIGION, NATIONAL ORIGIN, SEX, MARITAL STATUS, AGE, RECEIPT OF PUBLIC ASSISTANCE, OR GOOD FAITH EXERCISE OF ANY RIGHTS UNDER THE CONSUMER CREDIT PROTECTION ACT  
🗑
show AMENDED THE TRUTH IN LENDING ACT, REQUIRING CREDIT & CHARGE CARD ISSUERS TO PROVIDE CERTAIN DISCLOSURES IN DIRECT MAIL, TELEPHONE, & OTHER APPLICATIONS & SOLICITATIONS FOR OPEN-END CREDIT &CHARGE ACCOUNTS;LAW APPLIES TO PROVIDERS THAT ACCEPT CREDIT CARDS  
🗑
show FEDERAL LAW PASSED 1975 THAT HELPS CONSUMERS RESOLVE BILLING ISSUES WITH CARD ISSUERS; PROTECTS IMPORTANT CREDIT RIGHTS, INCLUDING RIGHTS TO DISPUTE BILLING ERRORS, UNAUTHORIZED USE OF AN ACCOUNT, AND CHARGES FOR UNSATISFACTORY GOODS AND SERVICES  
🗑
show PROTECTS INFO. COLLECTED BY CONSUMER REPORTING AGENCIES SUCH AS CREDIT BUREAUS, MEDICAL INFORMATION COMPANIES AND TENANT SCREENING SERVICES;  
🗑
show SPECIFIES WHAT A COLLECTION SOURCE MAY AND MAY NOT DO WHEN PURSUING PAYMENT OF PAST DUE ACCOUNTS  
🗑
show PERSON RESPONSIBLE FOR PAYING HEALTHCARE FEES  
🗑
LITIGATION   show
🗑
MANUAL DAILY ACCOUNTS RECEIVABLE JOURNAL/DAY SHEET   show
🗑
show ANY PROCEDURE OR SERVICE REPORTED ON A CLAIM THAT IS NOT INCLUDED ON THE PAYER'S MASTER BENEFIT LIST, RESULTING IN DENIAL OF THE THE CLAIM;  
🗑
NONPARTICIPATING PROVIDER (NONPAR)   show
🗑
OPEN CLAIM   show
🗑
OUT-OF-POCKET PAYMENT   show
🗑
OUTSOURCE   show
🗑
show CONTRACTS WITH A HEALTH INSURANCE PLAN AND ACCEPTS WHATEVER THE PLAN PAYS FOR PROCEDURES OR SERVICES PERFORMED  
🗑
show ONE THAT HAS NOT BEEN PAID WITHIN A CERTAIN TIME FRAME (E.G., 120 DAYS)  
🗑
show A COMPUTERIZED PERMANENT RECORD OF ALL FINANCIAL TRANSACTIONS BETWEEN THE PATIENT AND THE PRACTICE  
🗑
show ANY MEDICAL CONDITION THAT WAS DIAGNOSED AND/OR TREATED WITHIN A SPECIFIED PERIOD OF TIME IMMEDIATELY PRECEDING THE ENROLLEE'S EFFECTIVE DATE OF COVERAGE  
🗑
show ASSOCIATED WITH HOW AN INSURANCE PLAN IS BILLED- THE INSURANCE PLAN RESPONSIBLE FOR PAYING HEALTHCARE INSURANCE CLAIMS FIRST IS CONSIDERED PRIMARY  
🗑
show REMITTANCE ADVICE SUBMITTED BY MEDICARE TO PROVIDERS THAT INCLUDES PAYMENT INFORMATION ABOUT A CLAIM  
🗑
show THE ROUTING SLIP, CHARGE SLIP, ENCOUNTER FORM, OR SUPERBILL FROM WHICH THE INSURANCE CLAIM WAS GENERATED  
🗑
show TERM USED FOR AN ENCOUNTER FORM IN THE PHYSICIAN'S OFFICE  
🗑
show PENDING  
🗑
TWO-PARTY CHECK   show
🗑
show GENERATED FOR PROVIDERS WHO DO NOT ACCEPT ASSIGNMENT; ORGANIZED BY YEAR  
🗑
show SERVICES THAT ARE PROVIDED TO A PATIENT WITHOUT PROPER AUTHORIZATION OR THAT ARE NOT COVERED BY A CURRENT AUTHORIZATION  
🗑
UNBUNDLING   show
🗑
show CLEARINGHOUSE THAT INVOLVES VALUE-ADDED VENDORS, SUCH AS BANKS, IN THE PROCESSING OF CLAIMS; USING A VAN IS MORE EFFICIENT AND LESS EXPENSIVE FOR PROVIDERS THAN MANAGING THEIR OWN SYSTEMS TO SEND AND RECEIVE TRANSACTIONS DIRECTLY FROM NUMEROUS ENTITIES  
🗑


   

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.

 
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
Created by: Tina Everett