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Medicare Secondary Payer (MSP) claims
claims that are submitted to another company before they are submitted to Medicare
RE-Verify Patient Information
Health insurance professionals should re-verify patient information at least once a year
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
the number that is assigned by the internal Revenue Service (IRS) and used as the employer identifier standard for all electronic health care transactions
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
A series of files set up chronologically and labeled according to the number of days since a claim was submitted
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
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
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
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