Round 1
What two types of "claims" can be submitted?
Paper or electronic
What do items numbers 1-13 on the CMS-1500 refer to?
What are the type of providers that the HIPAA 837 claim requires?
Billing, pay-to provider, rendering, referring
What describes a situation in which a CMS-1500 paper claim needs to be printed and sent to payer?
dropping the paper
What format is mandated by HIPAA for electronic health care claims?
837 on HIPAA claim
Which type of claim is the most expensive?
Paper
What is he direct transmission approach?
Providers and payers exchange transactions without using a clearinghouse.
What is destination payer?
Health plan receiving a HIPAA claim
What is the term used to identify an alternative physician or professional who provides the procedure on a claim?
rendering provider
What are four types of data elements?
required, required if applicable, not required with contract, not required
What is the paper claim called?
1500
997
Documentation a prover sends a payer to support a claim?
claim attachment
If a practice uses a billing service which provider does it identify with?
billing provider
How is term subscriber used on the HIPAA 837 claim form?
same as insured
What is the paper claim called?
Form 1500
What are PMP vendors responsible for?
Keeping products up to date, receive certification from HIPAA vendors and training office personnel.
What is a clean claim?
claim accepted by a health plan for adjudication
E codes cannot be used as a ______
Primary diagnosis
Give an example of a data element.
patient data
What is the CMS 1500?
What are one of the five major sections of the claim?
Provider, subscriber, payer, claim details, services.
What are some common errors on a clean claim?
Missing or invalid patient birth date, missing part of the name, or invalid procedure codes
What is a taxonomy code?
administrative code set used to report a physician’s specialty
Why was the CMS-1500 updated?
Allow space for HIPAA mandates