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Medicare Secondary Payer (MSP) claims

claims that are submitted to another company before they are submitted to Medicare


the process of calling for a review of a decision made by a third party carrier

Medicare Appeal process

it begins when disagreement arises with the carrier's payment determination

Medicare Review Request part B

Part B appeals must come within 120 days

Claims Process

the process begins when the patient first contacts the office for an appointment

RE-Verify Patient Information

Health insurance professionals should re-verify patient information at least once a year

Dual Coverage

the health insurance professional should determine which carrier is primary

Authorization Release information

Many medical practices include a section (often positioned at the bottom of the form) for the patient to sign


Services that ti\ypically require preauthorization or percertification include in patient hospitalization

Once Claim is Completed

To help reduce claims rejection and delay, it is good practice for it to be proofread

Insurance Claim Form

the most important document i the medical insurance process

Group Number

the number that is assigned by the internal Revenue Service (IRS) and used as the employer identifier standard for all electronic health care transactions

Judgement Ruling

This is the process when after the claim has been recieved by a third-party payer, it is reviewed, and the carrier makes payment decisions.

Optical Recognition Scanner (OCR)

A device used when the insurance carrier receives a paper claim to date and process the claim

Suspension File

A series of files set up chronologically and labeled according to the number of days since a claim was submitted

Insurance Claims Register

A columnar form on which insurance claims are tracked

Explanation of Benefits

Document sent by the insurance carrier to provder/patient explaining how the claim was adjudicated

EOB (Exaplanation of Benefits)

The key to knowing how much of the claim was paid, how much was not and why


Submitting claims with outdated, deleted, or nonexistent CPT codes

30 days

This is ideally, the number of days when insurance claims should be submitted to the insurance carrier


This is who the ehalth insurance professional should contact if there is a question as to time limits for filing claims

Secondary Insurer

The insurance company who pays after the primary carrier

If in the case of dual coverage

If it is not immediately obvious which payer is primary, the health insurance professional should first ask the patient

Block 11A

if there is a second insurance policy, it is important to check "yes" in this block

Coordination of Benefits

this is when a patient an dspouse (or parents) are covered under two separate group policies.

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