Medical Insurance Ch 8

The HIPAA X12 837 transaction that a provider uses to report professional, institutional, or dental claims and that is also used to send a secondary or tertiary payer claim with the primary payer's RA/EOB data.

Paper claim for physician services.

Organization responsible for the content of health care claims.

Current paper claim approved by NUCC

A provider's identification number issued by a payer before implementation of the National Provider Indentification system.

Data entry area located in the upper right of the CMS-1500 that allows for a four line address for the payer.

Two digit numeric or alphnumeric code used to report a special condition or unique circumstance about a claim; reported in Item Number 10d on the CMS-1500 claim form.

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.

Term used to identify the physician or other medical professional who provides the procedure reported on a health claim if other than the pay-to provider.

The person or organization (often a clearinghouse or billing service) sending a HIPAA claim, as distinct from the pay-to provider who receives payment.

Additional provider identification number supplied on a health care claim.

Two digit code for a type of provider identification number other than the National Provider Identifier (NPI)

Purchased laboratory services

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.