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
What is a clean claim?
EOB
What is Explanation of Benefits?
Insured's ID Number
What is Block 1A?
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)
What is 2001?
Sequencing of diagnostic codes
What is the primary diagnosis first, followed by any secondary or co-morbidity diagnoses?
A claim that has not been processed or cannot be processed for various reasons
What is a rejected claim?
NUCC
What is National Uniform Claim Committee?
Reserved for NUCC
What is Block 8?
This is what the CMS-1500 form stands for
What is the Centers for Medicare and Medicaid Services Form 1500?
Service Dates should be in this format
What is an 8-digit format?
This is a claim that has no staples or highlighted areas and on which the bar code area has not been deformed
What is a physically clean claim?
EIN
What is Employer Identification Number?
An indication that there is a holder of another policy that may cover the patient
What is Block 9?
This color the CMS-1500 claim form
What is red?
Medical services, hospital services, or office visits that are grouped if each visit is consecutive, occurs in the same month, uses the same procedure code, or results in the same fee.
What is Consecutive Dates?
This is a claim that has no staples or highlighted areas and on which the bar code area has not been deformed?
What is a physically clean claim?
SSN
What is Social Security number?
Patient Relationship to Insured
What is Block 6?
Number of diagnoses that can be reported on paper and electronic claim forms
What is 12 for paper and 8 for electronic claims?
True or False:
Curiosity visits are billed to the insurance company
What is False?
This is a claim submitted with errors, one requiring manual processing for resolving problems, or one rejected for payment
What is a dirty claim?
NPI
What is National Provider Identifier?
Is the insured’s permanent residence
What is Block 7?
The most common errors made when filling out a CMS 1500 claim form
Time frame to submit claims to payers
What is Filing Limit?