17 terms

Ch. 21 The Health Insurance Claim Form

assignment of benefits
the transfer of the patients legal right to collect benefits for medical expenses to provider of those services; the pt. authorizes sending of the payment directly to the provider.
a process done before claims submission to examine claims for accuracy and completeness. It can be performed manually, or it can be done electronically withe computer billing software.
audit trail
the path left by a transaction when it has been completed; often referred to when tracking medical services used by patients or researching claims
clean claim
an insurance claim form that has been completed correctly (no errors or omissions); these claims can be processed and paid promptly if they meet the restrictions on covered services and blocks.
a centralized facility to which insurance claims are transmitted. They separate, check, and redistribute claims electronically to various insurance carriers and may offer additional services to the physician.
direct billing
A method of electronic claims submission where computer software allows a provider to submit an insurance claim directly to an insurance carrier for payment.
dirty claim
a claim form that contain errors or omissions; they must be corrected and resubmitted to an insurance carrier to obtain reimbursement.
electronic claim
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 (or 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 Internal Revenue Service to identify a business or individual functioning as a business entity for income tax reporting.
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 unto 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)
paper claim
a hard copy of an insurance claim; which is completed and sent by surface mail.
rejected claims
Claims returned unpaid to the provider for clarification of any question and that must be corrected before resubmission.
Unique Provider Identification Number
(UPIN) a number assigned by fiscal intermediaries to identify providers on claims for services.
universal claim form
The form used to submit all government-sponsored claims; also known as the CMS-1500.