Corrected Claims
When a provider submits additional information on a new claim.
What is a Corrected Claim.
What does CARF stand for?
What is Claim Action Request Form.
What does COB stand for?
What is Coordination of Benefits.
This adjustment type must increase the original payment and issue additional benefit.
What is Supplemental.
This part of Medicare is medical insurance to pay for medically necessary services and supplies provided by providers.
What is Medicare Part B.
A federal law that, among other things, regulates health benefit plans.
What is Employee Retirement Income Security Act (ERISA).
Fill in the blanks.
The last digit of the ____ __ ____ on a facility claim may also indicate a possible corrected claim.
What is Type of Bill.
What rule applies when a member is covered by more than one Blue Cross policy?
What is the Blue on Blue Primacy rule.
Reverses an overpayment set up in error.
What is Overpayment Reversal
This part of Medicare is a combination of Part A and Part B that is provided by approved private insurance companies.
What is Medicare Part C.
A claim that has not finalized or is being worked by the Claims Department.
What is a Front End Claim.
This type code is located in the FRQ field on Pac View 1.
What is the Frequency Type Code.
The plan that will process the claim after the primary plan has made their benefit determination.
What is the Secondary Plan.
Used to change claim data, but does not change financial records or benefit issued on the original claim.
What is Statistical Adjustment.
The part of Medicare that covers prescription drugs.
What is Medicare Part D.
When a corrected claim will result in ______ for any dollar amount, there is no dollar threshold on the request.
What is Recovery.
This type of edit indicates that an electronic claim is a possible corrected or voided claim.
What is a PAJ edit.
The plan obligated to make a benefit determination before any other plan.
What is Primary Plan.
Partially Reverses a claim payment
What is Partial Credit Adjustment.
This part of Medicare helps pay for inpatient hospice care, inpatient Skilled Nursing Facility, home health and hospice care.
What is Medicare Part A.
When this type of edit is applied to a corrected claim, the corrected claim is considered first. You do not automatically deny the corrected claim for this timely filing issue without reviewing the claim for an adjustment to the original claim.
What is a Timely Filing Edit.
This edit indicates that a paper claim is a possible corrected claim.
What is an SCB edit.
The plan that will process the claim after the primary and secondary plans have made their benefit determinations.
What is the Tertiary Plan.
Completely reverses a claim payment.
A federal health insurance program for people age 65 or older, certain disabled people under 65 years age, and individuals with End Stage Renal Disease.
What is Medicare.