chapter 7 insurance
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| who developed the standard form | health insurance association of america and american medical association
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| state the name of the insurance for approved by the american medical association | health insurance claim form
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| does medicare accept the CMS-1500 claim forms | yes
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| what is dual coverage | the patient has 2 insurance policies, one of which is considered primary and the other secondary
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| the insurance company with the first responsibility for payment of a bill for medical services is known as the | primary payer
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| what important document must you have before an insurance company can photocopy a patients chart | release of information form signed by patient
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| if the patient brings in a private insurance form that is not group insurance, where do you send the form after completion | to the insurance company
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| an insurance claim is returned for the reason "diagnosis incomplete." state one or more solutions to this problem on how you would try to obtain reimbursement | verify and submit correct diagnostic codes by referring to an updated diagnostic code book and reviewing the patient record
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| when preparing a claim that is to be optically scanned, birth dates are keyed in with how many digits | 8 digits
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| define this abbreviation: MG/MCD | Medigap and medicaid coverage
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| claim missing required information | incomplete claim
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| phrase used when a claim is held back from payment | pending claim
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| claim that is submitted and then optically scanned by the insurance carrier and converted to electronic form | paper claim
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| claim that needs manual processing because of errors or to solve a problem | dirty claim
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| claim that needs clarification and answers to some questions | rejected claim
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| claim that is cancelled or voided if incorrect claim form is used or itemized charges are not provided | delete claim
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| claim that is submited via telephone line or computer modem | electronic claim
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| claim that is submited within the time limit and correctly completed | clean claim
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| medicare claim that contains information that is complete and necessary but is illogical or incorrect | invalid claim
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| a number issued by the federal government to each individual for personal use | social security number
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| a medicare lifetime provider number | national provider identifier
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| a number listed on a claim when submitting insurance claims to insurance companies under a group name | group national provider number
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| a number that a physician must obtain to practice in a state | state license number
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| a number used for billing for supplies and equipment | durable medical equipment number
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| a number issued to a hospital | facility provider number
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| an invididual physicians federal tax identification number issued by the revenue service | employer identification number
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| a three part information form that is completed and signed by an insurance agent and an individual to obtain insurance coverage, and requires a medical examination by a physician is known as | life or health insurance application
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| the insurance claim form required when submitting medicare claim is | CMS-1500 claim form
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| the maximum number of diagnostic codes in the ANSI 837P claim format for transmitting electronic health insurance claim is | eight
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| if a patients gender is not indicated in the CMS-1500 claim form, the gender block defaults to | female
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| if a provide of medical services does not have an NPI number, the characters or digits that must be entered in block 24I is | IC
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| a photocopy of a claim form may be optically scanned | false
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| handwritting is permitted on optically scanned paper claims | false
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| a CMS-assigned national provider identifier (NPI) number consists of 10 characters | true
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| when listing a diagnostic code on an insurance claim, insert the decimal points | false
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| a diagnosis reference pointer should be entered in block 24E and not an ICD-9-CM diagnostic code | true
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