Admin Table of Contents
- 1 What is a claim called that contains all required data elements needed to process and pay the claim quickly?
- 2 Which is a procedure or service reported on a claim that is not included on the payer’s master benefit list resulting in denial of the claim?
- 3 Which is the electronic or manual transmission of claims data to payers?
- 4 What are the two types of claim form?
- 5 What is associated with an unassigned claim?
- 6 Which is a document that contains a computer generated list of procedures services and supplies with charges for each?
- 7 Is the manual or electronic transmission of claims data to payers or clearinghouses for processing?
- 8 What is electronic data exchange in healthcare?
- 9 How are clean electronic claims submitted to the payer?
- 10 What do providers accept as payment on a claim?
What is a claim called that contains all required data elements needed to process and pay the claim quickly?
provider that contracts with a health insurance plan and accepts whatever the plan pays for procedures or services performed. a series of fixed-length records submitted to payers as a bill for healthcare services. clean claim. claim that contains all required data elements needed to process and pay the claim.
Which is a procedure or service reported on a claim that is not included on the payer’s master benefit list resulting in denial of the claim?
Processing an Insurance Claim
| Question | Answer |
|---|---|
| Any procedure or service reported on a claim that is not included on the payer’s master benefit list, resulting in denial of the claim; also called noncovered procedure or uncovered benefit. | Noncovered Benefit |
What is the best way to deal with delinquent claims?
verify health plan identification information on all patients. Which is the best way to prevent delinquent claims? the deliquent claims are resolved directly with the payer.
Which is the electronic or manual transmission of claims data to payers?
CLAIMS SUBMISSION is the electronic or manual transmission of claims data to payers or clearinghouses for processing.
What are the two types of claim form?
As previously mentioned, there are two types of claims in health insurance, Cashless and Reimbursement Claims.
What are different types of claims in healthcare?
Click on the links below for more information about different claim types:
- First Party Insurance Claims.
- General Claims.
- Car Insurance Claims.
- Health Insurance Claims.
- Homeowner Claims.
- Natural Disaster Claims.
What is associated with an unassigned claim?
Unassigned claim means claim submitted for a service or supply provided by a physician or a supplier who does not accept assignment. If a physician or supplier does not agree to accept medicare’s approved charge as the total charge, then his/her claim is called an unassigned claim.
Which is a document that contains a computer generated list of procedures services and supplies with charges for each?
understanding health insurance 4 5 9 10
| Question | Answer |
|---|---|
| chargemaster (charge description master)(CDM) | A document that contains a computer-generated list of procedures, services, and supplies with charges for each. |
What is the first step in processing a claim?
Primarily, claims processing involves three important steps:
- Claims Adjudication.
- Explanation of Benefits (EOBs)
- Claims Settlement.
Is the manual or electronic transmission of claims data to payers or clearinghouses for processing?
Health Ins. Chapter 4
| Question | Answer |
|---|---|
| The transmission of claims data to payers or clearinghouses is called claims: | submission |
| Which facilitates processing of nonstandard claims data elements into standard data elements? | clearinghouse |
What is electronic data exchange in healthcare?
Electronic Data Interchange (EDI) is the automated transfer of data between a care provider and a payer. Using EDI allows payers and care providers to send and receive information faster, often at a lower cost.
Which is clearinghouse processes non-standard data elements?
Clearinghouse Public/private entity that processes or facilitates the processing of these non standard data elements (paper claims) into standard elements (electronic claims); also vice versa Electronic healthcare network accreditation commission
How are clean electronic claims submitted to the payer?
Clean Electronic claims are submitted directly to the payer after being checked for accuracy by billing software or a health care clearinghouse, which results in a ________ claim that contains all required data elements needed to process and pay the claim. Claims attachment
What do providers accept as payment on a claim?
Provider accepts as payment in full whatever is paid on the claim by the payer (except for any copayment and /or coinsurance amounts Didn’t know it?