Explore the essentials of processing insurance claims in Chapter 4: Processing an Insurance Claim. This quiz assesses understanding of direct reimbursements, Medicare communications, claims submission, and the role of clearinghouses. It's ideal for learners in healthcare management or insurance processing roles.
Electronic flat file
Encounter form
Ledger
Medicare summary notice
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Adjucation
Assignment
Processing
Submission
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Clearinghouse
EHNAC
Payer
Provider
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Flat file format
Funds transfer
Remittance adice
Source document
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EHNAC which accredits clearinghouses
Private sector payers that process electronic claims
Provider that submits paper based CMS-1500 claims
Small self administered health plan that processes manual claims
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Clean claim
Closed claim
Delinquent claim
Open claim
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Facsimile machine
Magnetic tape
Scanning device
Software that prints claims
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Accounts recievable
Claims attachment
Common data file
Electronic remittance advice
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Accept assignment
Assignment of benefits
Coordination of benefits
Pre-existing condition
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Adjucation
Authorization
Processing
Submission
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Clearing house converts electronic claims into electronic flat file format
Clearinghouse verifies claims data and transmits to payers
Health insurance specialist batches and submits claims to clearinghouse
Health insurance specialist completes electronic or paper based claim
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Adjucation
Processing
Submission
Transmission
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Medically unnecessary
Non-covered benefit
Pre-existing condition
Unauthorized service
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Common data file
Encounter form
Patient ledger
Remittance advice
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Coinsurance
Copayment
Deductable
Insurance
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Clearinghouse transmits claims data to payers
Payer approves claim for payment
Payer generates remittance advice
Payer performs claims validation
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Nonparticipating provider
Out-of-network provider
Participating provider
Value-added provider
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The parent whose birth month and day occurs earlier in the calender year is the primary policy holder
The parent who was born first is the primary policy holder
Both parents are primary policy holders
The parent whose income is higher is the primary policy holder
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Chargmaster
Day sheet
Encounter form
Superbill
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Aetna California
Blue Cross Blue Shield Florida
Home Health Agency
Medicaid
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Equal Credit Opportunity Act
Fair Credit Reporting Act
Fair Dept Collection Practices Act
Truth In Lending Act
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Equal Credit Opportunity Act
Fair Credit Reporting Act
Fair Debt Collection Practices Act
Truth In Lending Act
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Attach supporting medical documentation on claims
Enter all claims data in the in the practices suspense file
Submit closed claims to all third-party payers
Verify all health plan identification information on all patients
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Delinquent claims are outsourced to a collection agency
The delinquent claims are resolved directly with the payer
The accounts receivable aging report was not submitted
The provided remittance notice was delayed by the payer
Quiz Review Timeline (Updated): Mar 22, 2023 +
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