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That pesky form...
Claims, Claims, Claims
Insurance
How do I process all this information?
And still there's more!
100
Paper claim for physician services.
What is CMS-1500?
100
Medicare's timely filing requirement is
What is one year.
100
A _________ insurance pays first up to the limits of its coverage.
What is primary?
100
Claims that are accurate and complete with all the information needed for processing in a timely fashion.
What is a clean claim?
100
Who can make revisions to the CMS-1500?
What is National Uniform Claim Committee (NUCC)?
200
Currently mandated paper claim for hospital billing.
What is UB-04 (Uniform Billing 2004)?
200
Claims submitted by people covered by a primary and secondary insurance plan
What is a cross-over claim?
200
Determines which insurance plan is primary and which is secondary.
What is coordination of benefits?
200
Processes Medicare Parts A & B claims from hospitals, physicians and other providers.
What is Medicare Administrative Contractor (MAC)?
200
Who has to APPROVE new versions of CMS-1500?
What is White House Office of Management and Budget (OMB)?
300
The electronic claim format for facilities
What is 837-I?
300
The implementation of this made the transfer of information more efficient, reduced handing time, minimized the risk of lost documents, reduced the burden on staff, lowered operating costs, and improved data integrity.
What is Electronic Data Interchange (EDI)?
300
A______ insurance will pay the agreed limits if the primary insurance did not cover all the cost.
What is secondary insurance?
300
The report sent from the third-party payer to the provider that reflects any changes made to the original billing.
What is a remittance advice (RA)?
300
The paper form 837-I corresponds to this paper form when filing claims.
What is Uniform Billing 2004 (UB-04)?
400
The electronic claims form used for professionals
What is 837-P?
400
The exception to submitting claims electronically is that paper claims may be sent to______.
What is clearinghouses?
400
This is a claim submitted by people covered by a primary and secondary insurance plan.
What is crossover claim?
400
The amount an insurer will accept as full payment minus applicable cost sharing.
What is the allowable charge?
400
Unique 10-digit code for providers required by HIPAA.
What is National Provider Identifier (NPI)?
500
The act that is part of HIPAA which mandated healthcare care claim forms be submitted electronically.
What is Administration Simplification Compliance Act (ASCA) of 2012.
500
For professional claims the ______ date is used to determine the date of service.
What is the "from" date?
500
If the primary insurance doesn't pay within _____ days, the provider is allowed to bill Medicare.
What is 120?
500
The RA reflect any changes made to the original billing. Adjustments fall into one of the following categories: (Name 3)
What is: denied claim, zero payment, partial payment, reduced payment, penalty applied, additional payment, orsupplemental payment.
500
Plan that allows patients to only go to physicians, other healthcare professionals or hospitals on a lies too approved providers except in an emergency.
What is Health Maintenance Organization (HMO)?