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Chapter 7 review

Who developed the standard form

Health Insurance Association and American Medical Association

Name of the insurance form approved by the American Medical Association

Health Insurance Claim Form

What form is excepted by Medicare

CMS-1500 (08-05)

When two insurances are involved-one primary,one secondary

dual coverage

What important document must you have before an insurance company can photocopy a patients chart

Authorization form

Solutions to an insurance claim returned for the reason "diagnosis incomplete"

1) Update encounter form twice a year, 2)Verify and submit correct diagnosis codes by referring to an updated diagnosis code book and review pt records, 3) check w/physcian if diagnosis code listed does not go w/proceedure code shown

If a patient brings in a private insurance form that is not group insurance, where do you send the form

To the insurance carrier

When preparing a claim that is optically scanned, birth dates are keyed in with how many digits


Difine abreviation: MG/MCG


Claim missing required information

incomplete claim

Phrase used when a claim is held back from payment

pending claim

Claim that is submitted and then optically scanned by the insurance carrier and converted to electronic form

paper claim

Claim that needs manual processing because of errors or to solve a problem

dirty claim

Claim that needs clarification and some questions answered

rejected claim

Claim that is canceled or voided if incorrect claim form is used or itemized charges are not provided

deleted claim

Claim that is submitted via telephone line or computer modem

electronic claim

Claim that is submitted within the time limit and correctly completed

clean claim

Medicare claim that contains information that is complete and necessary but is illogical or incorrect

invalid claim

A number issued by the federal goverment to each individual for personal use

Social Security number

A Medicare lifetime provider number

National Provider Identifier

A number listed on a claim when submitting insurance claims to insurance companies under a group name

Group National Provider number

A number that a physician must obtain to practice in a state

State license number

A number used for billing for supplies and equipment

Durable medicall equipment number

A number issued to a hosptial

Facility provider number

An individual physcian's federal tax identification number issued by the Internal Revenue Service

Employer Identification number

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