Electronic Claims
Clearinghouses
Electronic Standard HIPAA 837P
Standard Unique Identifiers
Building the Claim
100
What is electronic data interchange?

exchange of data through computer systems. 

100

Claims are sent to clearinghouses in ___. 

batches

100

Who formed the Accredited Standards Committee X12 (ASC X12)?

American National Standards Institute (ANSI)

100

What number is assigned to employers by the IRS?

employer identification number (EIN)

100

An ____ is a document used to record information about the service rendered to a patient. 

encounter form 

200
What makes data look like gibberish?

encryption 

200

What is a clearinghouse?

An entity that receives the EDI from the health care organization's office and translates it to a standard format prescribed in HIPAA regulations. 
200

True or false

Version 5010 allows providers and payers to transmit ICD-10 data

True

200
What does NPI stand for?

National Provider Identifier 

200

True or False

Batched claims cannot be divided according to insurance type or date(s) of service. 

False

300

What is an advantage of electronic claims?

editing software for errors 

300

Claims are ___ for missing or incorrect information.

scrubbed 

300
True or false

The 837P is the National Standard Format for electronic claims submission by physicians, which replaces the paper CMS-1500 form. 

True 
300

What is HPID?

assigned a standard identifier to identify health plans that process and pay certain electronic health care transactions. 

300

What is an encoder?

Add-on software to a PMS that can greatly reduce the time it takes to build or review a claim before batching and can improve overall coding accuracy. 

400

how soon after a claim has been received will the payment be issued?

2 weeks or less

400

What are some benefits of clearinghouses?

reduction in time of claims preparation, fewer claim rejections, consistent reimbursement, etc. 

400

True or False

CPT, ICD-10, and HCPCS codes are referred to as medical code sets and are standardized under HIPAA. 

True 

400

All providers are required to have an ___to file a claim. 

NPI

400

According to industry experts, _ of claim denials are preventable. 

90%

500

How long does a paper claim take to receive payment?

4 to 6 weeks 

500

What happens if errors are found at the clearinghouse?

the claim is rejected and not forwarded to the payer 

500

ASC X12 Version 5010 allows providers to submit claims 

with ICD-10-CM/PCS codes

500
The adoption of the ___ increased standardization within HIPAA standard transactions and provide a platform for other regulatory initiatives. 

HPID

500

What is a notice of payments and adjustments sent to providers, billers, or suppliers called?

electronic remittance advice

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