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assignment of benefits
the transfer of the patient's legal right to collect benefits for medical expenses to the provider of those services, authorizing the payment to be sent directly to the provider
the process of examining claims for accuracy and completeness before submitting the claims; can be performed manually or 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 centralized facility to which insurance claims are transmitted; separates, checks, and redistributes claims electronically to various insurance carriers
a method of electronic claims submission in which computer software allows a provider to submit an insurance claim directly to an insurance carrier for payment
a claim form that contain errors or omissions; must be corrected and resubmitted to an insurance carrier to obtain reimbursement
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 (EDI)
the transfer of data back and forth between two or more entities using an electronic medium
electronic (digital) signature
a scanned signature or other such mark that is accepted as proof of approval of and/or responsibility for the content of an electronic document
employer identification number (EIN)
the number used by the IRS to identify a business or individual functioning as a business entity for income tax reporting
claim returned unpaid to the provider for clarification of any question; must be corrected before resubmission
intelligent character recognition (ICR)
the electronic scanning of printed blocks as images and the use of special software to recognize these images (or characters) as ASCII text for upload into a computer database
National Provider Identifier (NPI)
a lifetime number consisting of 10 digits that Medicare uses to replace the Provider Identification Number (PIN) and the Unique Physician Identification Number (UPIN)
Unique Provider Identification Number (UPIN)
a number assigned by fiscal intermediaries to identify providers on claims for services
any company, individual, or group that provides medical, diagnostic, or treatment services to a patient
the universal claim form developed by the HCFA, now know as the CMS and approved by the AMA for use submitting all government-sponsored claims
ASC X12N 837P (HIPPA Health Care Claims Professional)
the transaction and code set for the CMS-1500 electronic claims submission
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