INS chapter 7
Order by
20 terms
Terms | Definitions |
|---|---|
 clean claim | claim was submitted within the program or policy time limit and contains all necessary info |
| deleted claim | canceled, deleted or voided by Medicare for reasons in book, p. 214 |
| dirty claim | submitted with errors, one requiring manual processing or rejected for payment |
| durable medical equipment number | group or individual provider number used when submitting bills for medical supplies/equipment for payment |
| electronic claim | submitted via dialup, DSL or internet via FTP |
| employer ID# | each dr has a federal tax number issued by IRS |
| FACILITY provider number | a facility's provider number used to bill for services to show WHERE procedure was done |
| health insurance claim form | universal claim form accepted by most places known as "CMS-1500" |
| incomplete claim | claim missing required information |
| other claims | claims not clean and require investigation or development on a prepayment basis |
| paper claim | claim submitted on paper, including optically scanned |
| pending claim | held in suspense for review by third party payer |
| physically clean claim | no staples or highlighted areas, bar code has not been deformed |
| rejected claim | has not been/can't be processed for reasons p 213 |
| SSN | for personal use |
| state license number | needed to practice within that state |
| invalid claim | claim that contains complete and necessary info but is illogical or incorrect |
| NPI and group NPI | national provider identifier (NPI) - single or group practice - lifetime 10 digit number recognized by most insurance providers |
| durable medical equipment number | used to bill Medicare for supplies and equipment charged to the patient from the dr |
| OCR and ICR | scanner is used to transfer printed or typed text and bar codes to the insurance companies. fast to reduce data entry cost/processing time |
First Time Here?
Welcome to Quizlet, a fun, free place to study. Try these flashcards, find others to study, or make your own.