Types of Forms
This claim form has 6 service lines
What is a CMS 1500 claim form?
In this field the principle diagnosis code will go for the UB04 (CMS 1450)
What is field 67?
Name the three ways a claim can be submitted.
What is paper, electronic (EDI) and through the web portal?
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Treatment Authorization Codes (Prior Auths) go in this field ___ on a CMS 1500 claim form, and this field ___ on a UB04 claim form.
What is field 23 on a CMS 1500 form, and
What is field 63 on a UB04 form.
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True or False
OMNI can be used to view rejected claim codes?
What is True.
True or False
The Place of Service (POS) and Type of Bill (TOB) houses information for where the services are rendered on CMS claim forms.
What is TRUE
In this field you can find a CLIA number or Referral number of the servicing provider for an office visit.
What is field 23 of the CMS 1500 claim form?
What is the electronic Payer ID for Medical Claims?
What is 68069?
What are DME and DMS services?
What is Durable Medicare Equipment & Durable Medical Supplies.
What is the name of the vendor or department that sets up free EFT and ERAs for providers?
What PaySpan.
This claim form is also know as the HCSPCS claim form.
What is CMS 1500 claim form.
The Type of Bill goes in this field on a UB04
What is Field 4 on the CMS 1450?
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Ancillary Services, CRNA, Hospital based phyician Technical Components, and Professional charges are billed o this claim form
What 1500 Claim Form?
Ambulatory surgery centers, Outpatient hospital charges, and Dialysis services are billed on this form.
What is a UB04 for the services?
Where would vision and dental claims be processed for Centene?
What is Envolve? They have their own claims department for both dental and vision claims reconciliation.
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Home Health Services are billed on this claim form
What is CMS 1450 or UB04?
Federal Tax ID (TIN) goes in this field on a UB04.
What is "field 5" of a UB04 claim form?
True or False
Explanation (EX) codes explain the reasons a claim will paid, pend or deny?
This is TRUE!
Clearing Houses go through this department if their payer system is not set up with our Health Plan(s) to submit electronic claims.
What is the EDI Department.
Which system pays out monies for claims processed? What is the name of that process?
What is Amisys? and claim adjudication
This claim form has 81 Field descriptions on it.
What is CMS 1450 or UB04 claim form.
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Revenue Codes go in this field of this type of claim form.
What is field 42, of a UB04 or CMS 1450 claim form?
Which system will you use to find claim notes for Disputes or Appeals?
What is CenPas and Amisys?
Durable Medical Equipment are billed using this claim form?
What is CMS 1500?
An operating provider's NPIs go in what field of a CMS 1450 UB04?
What is Field 77.