22 terms


The process of checkingand confirming that a pt is covered under an insurance plan is known as (test)
Eligibility verification
A provision in a health insurance policy in which two insurance carriers work together for payment so that there is no duplication of benefits paid between the primary insurance carrier and the secondary insurance carrier is called (test)
coordination of benefits
A type of tax-free savings account that allows individuals and their employers to set aside money to pay for health care expenses is known as (test)
Health savings accounts, Medical savings account, Flexibel spending account
The SOAP style of documentation that a physician uses to chart a pt. progress in the health record means (test)
Subjective, Objective, Assessment, Plan
When there is an underlying disease or other conditions are present at the time of the pt. office visit, this is termed (test)
The TRICARE fiscal year (test)
begins Oct. 1 and ends September 30
When an individual on TRICARE Prime shows you their identification card, it guarantees TRICARE eligibility. (test)
A three part info form that is completed and signed by an insurance agent and an individual to obtain insurance coverage, and requires a medical examination by a physician is known as
Life or health insurance application
The insurance claim form requird when submitting Medicare claims is
CMS - 1500 (08-05) claim form
The maximum number of diagnostic codes in the ANSI 837P claim format for transmitting electronic health insurance claims is
If a pt gender is not indicated in the CMS-1500 (08-05) claim form, the gender block defaults to
A photocopy of a claim form may be optically scanned.
Handwriting is permitted on optically scanned paper claims
A CMS-assigned NPE number consists of 10 charaters
When listing a diagnostic code on an insurance claim, insert the decimal points
A diagnosis reference pointer should be entered in Block 24E and not an ICD-9-CM diagnostic code
If the insurace carrier is a self-insured plan, a Medicaid or Medicare health maintenace org. or an Employee Retirement Income Security Act (ERISA) based plan, the insurance commissioner
Is not able to assist with carrier issues
A written request made to an insurance company to locate the status of an insurance claim is often referred to as
Inquiry, follow-up, tracer
An insurace claim transmitted to the third party payer that is rejected because it contains a technical error, such as missing the insured's birth date, is also known as
soft denial
When an electronic claim is transmitted for several services and one service is rejected for incomplete info, the solution is to
Add the required info and retransmit the rejected claim
A request for payment to a third-pary payer asking for a review of an insurance claim that has been denied is referred to as
If the provider has no contract with the insurace carrier, the provider is not obligated to the carrier's deadline.