This is an outside service to help providers send their electronic claims to payers
What is a Clearinghouse?
100
the term used by payers to indicate that more information is needed for claim processing
What is Development?
100
status for a claim means that the payer is waiting for information
What is Pending?
100
EFTs from a 3rd party payer go into this person's account.
What is the PROVIDER?
100
directl deposit payments into a bank account
What is EFT?
200
direct data entry , transmission through a clearinghouse and
direct transmission to the payer are examples of this
What is a method of transmitting a claim to a payer?
200
State prompt payment laws mandate a time period known as this, within which clean claims must be paid.
What is claim turnaround time ?
200
The date would the biller set the PM/EHR to automatically issue a HIPAA 276 for unpaid claims
What is the first date that the payment is overdue
200
Payments that are made to physicians on a regular basis for providing all contracted services to patients in a managed care insurance plan are known as this.
What is Capitation Payments?
200
If a payer has rejected all the appeal levels on a claim, the claimant can still do this
What is pursue the appeal with the state insurance commission
300
method of claim transmission in which a member of the provider’s billing staff manually enters claims into an application on the payer’s website.
What is Direct data entry (DDE)
300
This report lists the claims transmitted on each day and how long they have been in process with a particular payer.
What is insurance aging report ?
300
payments listed on an ERA (electronic Remittance Advice)are automatically applied to the appropriate account bvia this process
What is Autoposting?
300
This event can result in changing an initial determination
What is postpayment audit?
300
When the provider owes a refund due to a billing error, it is known as this.
What is an Overpayment?
400
During the payer’s adjudication process, if the automated review finds problems, the claim is given this status
What is suspended ?
400
The HIPAA 276/277 Health Care Claim Status Inquiry/Response is an electronic transaction that is used during this process.
What is the adjudication process ?
400
This is the term when a payer is paying a claim or a service line differently than billed
What is an Adjustment?
400
denial , reduction , or downcoding can cause the provider to do this
What is FILE AN APPEAL?
400
A denied claim can be appealed except for this
What is Not filed on time?
500
the adjudication step during which the payment decision is made
What is Determination?
500
From the point of view of the practice, HIPAA 276 is this.
What is an outgoing transaction?
500
This is the claim adjustment group code a payer would apply to indicate patient responsibility
What is PR?
500
After the primary payer's RA has been posted, the next step is to do this if the patient has additional insurance coverage
What is Bill the 2nd Payer?
500
This is A payer's escalating structure of appeals.