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assignment of benefits |
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The transfer of the patient's legal right to collect benefits for medical expenses to the provider of those services, authorizing the payment to be sent directly to the provider. |
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audit |
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A process done prior to claims submission to examine claims for accuracy and completeness. An audit can be performed manually or, if computer billing software isused, electronically. |
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audit trail |
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the path left by a transaction when it has been completed; often referred to when tracking medical services used by patients or researching claims. |
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clean claims |
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insurance claim forms that have been completed correctly (no errors or omissions) and cann be processed and paid promptly if they meets the restrictions on covered services and items. |
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clearinghouse |
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A centralized facility to which insurance claims are transmitted. Clearing houses separate, check and redistribute claims electronically to various insurance carriers and may offer additional services to the physician. |
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direct billing |
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a method of electronic claims submission where computer software allows a provider to submit an insurance claim directly to an insurace carrier for payment |
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dirty claims |
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Claims that contain errors omissions which must be corrected and resubmitted to an insurance carrier in order to obtain reimbursement |
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electronic claims |
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claims that are submitted to insurance processing facilities using a computerized medium. such as direct data entry, direct wire, dial-in telephone digital fax, or personal computer download or up load. |
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Electronic Data Interchange (EDI) |
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the transfer of data back and forth between two or more entities using an electronic medium |
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electronic ( or digital) signature. |
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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 |
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employer identification number (EIN) |
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the number used by the Internal REvenue Service that identifies a business or individual functioning as a business entity for income tax reporting. |
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incomplete claim |
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a claim that is missing information and is returned to the provider for correction and resubmission. this is sometimes also called an invalid claim |
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Intelligent Character Identifier (ICR) |
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the electronic scanning of printed items as images and use of special software to recognize these images (or characters) as ASCII text for upload into a computer database |
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National Provider Identifier (NPI) |
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a lifetime number consisting of 10 digits that Medicare will use to replace the Provider Identification Number (PIN) and the Unique Physician Identification Number (UPIN) |
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paper claims |
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Hard copies of insurance claims that have been completed and sent by surface mail. |
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provider |
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any company, individual, or group that provides medical, diagnostic, or treatment services to a patient |
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Provider Identification Numbers (PINs) |
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Number assigned to providers by a carrier for use in submission of claims. |
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Unique Provider Identification Number (UPIN) |
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a number assigned by fiscal intermediaries to identify providers on claims for services. |
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rejected claims |
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claims returned unpaid to the provider for clarification of any question and that must be corrected before resubmission. |
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Universal claim form |
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the form developedby the Health Care Fnancing Administration (HCFA) (now know as the Centers for Medicare andMedicaid Services (CMS) and approved by the AMA for use in submitting allgovernment sponsored claims Alsoknow as CMS-1500 form |
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