MedOffice7/8 Word Scramble
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Question | Answer |
Know about submitting documentation | Only send when insurance company requests it. Explain reason for attachment. Include Patient Name and I.D. number. |
Know when to bill no charges | Never submit a claim for services that have a NO CHARGE. These services are documented in the patient's medical and financial records. |
How do paper claims get submitted? | Submitted using the CMS-1500 form and mailing it to the insurance company. Now it is always computer generated,not hand typed. |
How do electronic claims get submitted? | Submitted directly to clearinghouse via computer by using the internet to transmit. Electronic claims never get printe to a CMS-1500 |
Know the agreement for elecronic claims submission | For the most part Medicar and Medicaid require all providers to submit their caims electronically. There are different ways to send claims to those offices. |
Know the functions of a clearinghouse | Duties to separate the clais b carrier, perform software edits, on each claim to check for errors, and transmit claims electronically to the correct insurance payer. |
Which provider number is used on insurance claim forms? | NPI. Lifetime 10-digit number |
Know about dual coverage | When a patient has two private insurance policies |
How many locations for diagnostic codes can be listed o the claim form? | Up to 4 diagnosis codes |
Netwroks | Computers may be iter-connectedin a numbe of different was to exchange info |
CMS-1500 | Th universal form for all insurance companies |
Clean Claim | Has no deficiencies and has passe all electronic edits. |
Incomplete Claim | Has missing information which is identified to the provider so that the claim can be corrected and resubmitted. |
Pending Claim | A claim that has been held in suspense while it is being reviewed or waiting for additional information. |
Rejected Claim | Needs further clarificaton and answers to questions |
Know about entering data for OCR claims | OCR guidelines require that all entries inserted appear in capital letters wit no punctuation, and no comments in blocks that do not apply. |
Know the two ways claims can be tranmitted electronically | Carrier Direct and clearnghouse |
Know where the insurance company name and address are listed on the claim form | Inserted in top right corner of claim form |
Know the two sections of the claim form | Patient/insured information and physician/supplier information |
Know about NEIC systems | Provides a national network to receive, process, edit, sort, and transmt electronic caims to insurers. Allows the physician to use one version of software to communicate with different insurers. |
Created by:
sanzijessica
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