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Chapter 7: Health Care Claim Preparation and Transmission
Terms in this set (30)
The format for electronic claims
The HIPAA-mandated electronic transaction for claims; also called HIPAA claim.
administrative code set
Under HIPAA, required codes for various data elements, such as taxonomy codes and place of service (POS) codes.
The person or organization (often a clearinghouse or billing service) sending a HIPAA claim as distinct from the pay-to provider who receives payment
Data entry area located in the upper right of the CMS-1500 that allows for a four-line address for the payer.
Documentation that a provider sends to a payer in support of a health care claim.
claim control number
Unique number assigned to a health care claim by the sender
claim filing indicator code
Administrative code used to identify the type of health plan.
claim frequency code (claim submission reason code)
Administrative code that identifies the claim as original, replacement, or void/cancel action.
A claim that is accepted by health plan for adjudication.
Paper claim for physician services.
The NUCC-revised paper claim with modified instructions.
Two-digit numeric or alphanumeric codes used to report a special conditon or unique circumstance about a claim.
A collection of related facts.
The smallest unit of information in a HIPAA transaction.
In HIPAA claims, the health plan receiving the claim.
electronic transaction for claims also called the 837P claim.
individual relationship code
Administrative code that specifies the patient's relationship to the subscriber (insured)
line item control number
On a HIPAA claim, the unique number assigned by the sender to each service line item reported.
National Uniform Claim Committee (NUCC)
Organization responsible for the content of health care claims.
Purchased laboratory services.
The person or organization that is to receive payment for services reported on a HIPAA claim; may be the same as or different from the billing provider.
place of service (POS) code
HIPAA administrative code that indicates where medical services were provided.
2-digit code for a type of provider identificaiton number other than the NationalProvider Identifier (NPI)
Term used to identify the physician or other medical professional who provides the procedure reported on a health care claim if other than the pay-to-provider.
Claims sent to a secondary payer reporting what the primary payer paid on the claim.
service line information
On a HIPAA claim, information about the services being reported.
Administrative code set under HIPAA used to report a physician's specialty when it affects payment.
Claims sent to a tertiary payer reporting what the primary and secondary payers paid on the claim.
THIS SET IS OFTEN IN FOLDERS WITH...
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