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TERMINOLOGY
MEDICARE/MEDICAID
HEALTHCARE PLANS
ROLES OF A MEDICAL ASSISTANT
OTHER
100
X12 837 Healthcare Claim
What is an electronic claim transactionn that is HIPPA Healthcare claim or equivalent Encounter form
100
What is formerly known as Medi/ Medi
Dual Coverage
100
Who is elgible for Tricare?
Famlies of uniformed personel and retirees
100
What is the information called when the that is entered on the electronic claim?
Data elements
100
How are physcians who contract with HMO paid?
capitated rates
200
Who are participating physcians enrolled by?
Managed Care Organizations
200
How many lifetime reserve days are you allowed in alifetime with Part A
60
200
What insurance plan is for dependent spouses and children of veterans with disabilites, also surviving spouces and dependent children of veterans who died in the line of duty or from service connected disabilities?
Champ Va
200
What is the one of the titles that the medical assistant may encounter while processing X12 837 healthcare claims?
X 276/277 claims inquiry status X 270/271 elgibility inquiry response X12 278referral authorization inquiry and response X12 835 payment and remittance X12 820health plan premium X12 834 enrollment in and withdrawl from a health plan
200
To be elgible for Tricare patients must also be nrolled in this?
DEERS
300
Who is the FIRST PARTY, SECOND PARTY, and THIRD-PARTY PAYER?
First party - Physcian second party - patient Third party - physcian
300
What are some basic services provided by Medicaid?
Physcian services Emergency Services Laboratory Services and X rays Skilled Nursing Facilities Early diagnostic screening and treatment for minors 21 & younger vaccines for children
300
What is the health care plan that is used by federal employees with Bluecross Blue shield.
Bluecross Blue shield Federal
300
What is one way the MA can submitt a claim?
Electronically
300
What is extra insurance coverage that can be purchased
Medigap
400
Preauthorization is approval in advance and precertification is determining if procedure is covered under patients insurance. What is the difference between preauthorization and precertification?
Preauthorization is approval in advance and precertification is determining if procedure is covered under patients insurance.
400
When obtaining prior authorization what do you need for
insurance group number ID name address phone and D/O/B
400
What healthcare plan has providers families can use on on a case by case basis without a required enrollment.
Tricare Extra
400
When authorization is recieved what do you record if obtained by phone?
authorization number name and extension of the person issuing authorization
400
This covers accidents or diseases incurred in the workplace
Workers Compensation
500
The patient and the practice both recieves this for each encounter that outlines the amount billed by the practice, the amount allowed, the amount of suscriber liability, the amount paid, and any notations of any services not covered, including an explanation of why that service is not covered.
Remittance Advice (RA)
500
December of the following year How long do you have to file a medicare insurance claims?
December of the following year
500
State Children's Health Plan This was enacted in 1997 and reauthorized in 2009, and it is provided by the state.
State Children's Health Plan
500
if authorization is recieved and but there is no authorization number on the claim form what happens to the claim
Denied
500
Billing a patient for services higher than usual fees and a lower alowed charge is called
Balance Billing