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21 terms

chapter 12

(Based on Previous Test)
STUDY
PLAY
1. Fee-for-service claims
are generally accepted nationwide by most commercial health insurance companies.
In Block 1 of the CMS-1500 claim
you should always place an X in the Other box when filing a commercial insurance claim.
Do not enter hyphens or spaces.
when entering a policyholder's commercial policy or group number
The shaded area in each line
is used to enter supplemental information to support reported services if instructed by the payer to enter such information
Disability insurance
reimburses individual for lost income as well as health care expenses
Most health insurance plans
are secondary to liability insurance.
Modifications are made to the CMS-1500 claim instructions
when patients are covered by primary and secondary or supplemental health insurance plans
Submit just one CMS-1500 claim
when the same payer issues the primary and secondary or supplemental policies
Although commercial claims completion instructions are generally recognized nationwide
it is important tocheck with each payer to determine if they require alternate information to be entered on the claim
Information is entered in Blocks 9 through 11 and just one just one claim is submitted
if the same payer provides both primary and secondary/supplemental coverage
The base period for a disability claim covers
12 months
Block 32 must be filled out
if services were provided at a location other than the provider's office or the patient's home, such as a hospital, outside laboratory facility, skilled nursing facility, or DMEPOS supplier
When filling out the CMS-1500 claim form, the policyholder's name should appear as
Last name - First name - Middle initial (separated with commas)
The patient's birth date should appear on the CMS-1500 claim as
MM DD YYYY
Leave Block 11a blank
if the policyholder's gender is unknown
Block 24 of the CMS claim is limited to reporting how many services
6
Supplemental health insurance plans usually cover
deductibles,copayments, coinsurance expenses
Liability Insurance
insurance that covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured.
The shaded area in each line is used to
enter supplemental information to support reported services, enter supplemental information when requested by the payer
In Block 33 of the CMS-1500 claim, the correct way to enter the provider's zip code is
12345,12345-6789
If a patient is covered by two different policies, the correct procedure for submitting the claim would be
the primary submitted first, followed by secondary after primary payment