assignment of benefits
the transfer of the patients legal right to collect benefits for medical expenses to provider of those services; Authorization by a policyholder that allows a health plan to pay benefits directly to a provider.
a process done before claims submission to examine claims for accuracy and completeness. an audit can be performed manually, or it can be done electronically with computer billing software.
the path left by a transaction when it has been completed; often referred to when tracking medical services used by patients or researching claims.
a completed insurance claim form submitted with the program time limit that contains all the necessary information without deficiencies so it can be processed and paid promptly
a company (billing service, repricing company, or network) that converts nonstandard transactions into standard transactions and transmits the data to health plans, also handles the reverse process, changing standard transaction from health plans into nonstandard formats for providers.
A method of electronic claims submission where computer software allows a provider to submit an insurance claim directly to an insurance carrier for payment.
Contains errors and omissions. Usually these claims do not pass front-end edits. They either are processed manually for resolving problems, or rejected for payment.
a claim submitted to an insurance processing facility through a computerized medium, such as direct data entry, direct wire, dial-in telephone digital fax, or personal computer download or upload.
electronic data interchange
The electronic transfer of information in a standard format between two entities. Allows business entities to exchange information and transact buisness in a rapid and cost-effective way
electronic (or digital) signature
A scanned signature or other such mark that is accepted as proof of approval of and/or reasponsibility for the content of an electronic document.
employer identification number
employer identification number (EIN) A number issued by the Internal Revenue Service to any medical facility, provider, or business for tax purposes.
intelligent provider number
the electronic scanning of printed blocks as images and theuse of special software to recognize these images as ASCII text for upload into a computer database
national provider identifier
NPI, A Medicare lifetime 10-digit number issued to providers. When adopted, it will be recognized by Medicaid, Medicare, TRICARE, and CHAMPVA programs and eventually may be used by private insurance carriers.
a hard copy of an insurance claim; which is completed and sent by surface mail.
Claims returned unpaid to the provider for clarification of any question and that must be corrected before resubmission.
unique provider identification number
(UPIN) a number assigned by fiscal intermediaries to identify providers on claims for services.
universal claim form
The form used to submit all government-sponsored claims; also known as the CMS-1500.