Claim Status
A claim that was submitted within a third party payer’s time limit and contains all necessary information so that it can be processed and paid promptly?
clean claim
ASCA
Administrative Simplification Compliance Act
Block 9d
It identifies the name of the plan or program of the other insured
2001
The HCFA-1500 became known as the CMS-1500 when the Health Care Finance Administration was retitled the Centers for Medicare and Medicaid Services (CMS)
Diagnosis
All accurate diagnostic codes that affect the patient’s condition should be inserted, with the primary diagnosis code listed first followed by any secondary or tertiary diagnosis codes.
A claim that has not been processed or cannot be processed for various reasons?
rejected claim
NUCC
National Uniform Claim Committee
Block 8
Reserved for NUCC
2005
It became necessary to change the CMS-1500 (12-90) so that it could accommodate reporting of the National Provider Identifier (NPI) for providers; this form was referred to as the CMS-1500 (08-05).
Service Dates
Dates of service must be entered with no spaces using a 6-digit or 8-digit format; for example, January 2, 20XX
This is a claim that has no staples or highlighted areas and on which the bar code area has not been deformed?
physically clean claim
EIN
employer identification number
Block 9
Is an indication that there is a holder of another policy that may cover the patient
2009
NUCC began revision of the 1500 Claim Form to accommodate the updated Electronic Claims Submission (Version 5010 837P) changes and implementation of the new diagnosis coding system, ICD-10.
Consecutive Dates
Some carriers allow medical services, hospital services, or office visits to be grouped if each visit is consecutive, occurs in the same month, uses the same procedure code, or results in the same fee.
This is a claim that has no staples or highlighted areas and on which the bar code area has not been deformed?
physically clean claim
SSN
Social Security number
Block 6
Patient Relationship to Insured
2012
NUCC released the revised version of the 1500 Health Insurance Claim Form (version 02-12), which accommodated changes needed for implementation of ICD-10.
No Charge
Insurance claims should not be submitted for services that have no charge, such as global or surgical package postoperative visit, unless the patient requests that it be sent.
This is a claim submitted with errors, one requiring manual processing for resolving problems, or one rejected for payment?
dirty claim
NPI
National Provider Identifier
Block 7
Is the insured’s permanent residence.
January 6, 2014
Health plans, clearinghouses, and other information support vendors were required to handle and accept the newly revised (02-12) form effective January 6, 2014. Providers were allowed to use either the 08-05 or the revised (02-12) 1500 Claim Form until March 31, 2014.
Provider’s Identification Numbers
Insurance companies and federal and state programs require certain identification numbers on claim forms to be submitted from health care organizations and service providers.