Basic Healthcare
Also total charge value of the claim. This is the amount charged for each service performed by the provider.
Billed Amount
It is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers.
CMS 1500
denial code for Deductible
PR 1
What does HIPPAA stands for ?
Health Insurance Portability and Accountability Act (HIPAA) of 1996
What is HCFA ?
Health Care Finance Administration
Also called the allowed amount. This is the maximum amount the payer will pay for a service based on our contract. Expected amount can be a combination of insurance paid amount and patient’s responsibility.
Expected Amount
It is an insured individual's share of the costs of a covered expense (it usually applies to healthcare insurance). It is expressed as a percentage.
Coinsurance
The time filing limit has expired
CO-29
NPI stands for ___.
National Provider Identifier
True or False : Claims are stored for 7 years for reporting.
TRUE
This is the amount that the insurance pays the provider. When there are patient’s responsibilities (PTR) such as deductible, coinsurance or copay, paid amount is difference of EA and PTR [EA = PA + PTR].
Paid Amount
It is the amount an insured person must pay out-of-pocket for a covered medical service before the insurance policy begins to pay for those services.
Deductible
Hospice, or patient is enrolled in a Hospice
CO B9
CPT
Current Procedural Terminology
In Which lifecycle of a claim where the insurance company reviews the claim details and determines the amount that will be paid.
Adjudication
is a statement from the patient’s health insurance plan describing what costs it will cover for medical care or products they received. It is generated when the provider submits a claim for the services were received.
Explanation of Benefit
What are the ways to submit the Claim ?
ELECTRONIC SUBMISSION
PAPER SUBMISSION
FAX SUBMISSION
SUBMISSION THRU WEB
Non covered charges
CO-96
CARC
Claim Adjustment Reason Code
What does EOP stands for and explain ?
The provider is paid and is informed as to which procedures are being paid via a statement called an "Explanation of Payments" or "EOP"
What is RCM
Revenue Cycle Management
It is the form used by hospitals, nursing facilities, ambulatory centers, and any other medical attention provider to receive and process the billing of medical and mental health claims.
UB 04 / hospital bill form
Medically not Necessary
CO-50, PR-204, CO-242
HCPCS
Healthcare Common Procedure Coding System
What are the 4 lifecycle of a Claim?
Claim Generation, Claim Submission, Adjudication and Reporting