# 7 Cms-1500

Front 1

clean claim

Back 1

submitted within program time limit containing all information without deficiencies

Front 2

deleted claim

Back 2

claim that has been cancelled, deleted, or voided by a Medicare fiscal intermediary

Front 3

dirty claim

Back 3

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

Front 4

DME number

Back 4

a number used when billing for supplies and equipment

Front 5

EIN

Back 5

Employer Identification Number: tax ID issued by the IRS

Front 6

facility provider number

Back 6

used to bill for services or by the performing physician to report services done at that location

Front 7

group NPI

Back 7

Group National Provider Number: listed on a claim when submitting claims under a group name

Front 8

incomplete claim

Back 8

any Medicare claim missing necessary information; such claims are identified to the provider so they may be resubmitted

Front 9

ICR

Back 9

Intelligent character recognition - same as optical character recognition

Front 10

invalid claim

Back 10

any Medicare claim containing complete information but is illogical or incorrect

Front 11

NPI

Back 11

National Provider Identifier: a Medicare lifetime, 10-digit number issued to providers

Front 12

"other" claims

Back 12

Medicare claims not considered "clean" that require investigation to determine if primary or secondary payer

Front 13

paper claim

Back 13

claim submitted on paper

Front 14

pending claim

Back 14

claim held in suspense because of review or other reason; may be cleared for payment or denied

Front 15

physically clean claim

Back 15

claims with no staples or highlighted areas; the bar code area has not been deformed

Front 16

rejected claim

Back 16

submitted claim discarded due to technical error; it is returned to provider for correction/change

Front 17

CLIA

Back 17

Clinical Laboratory Improvement Amendments

Front 18

DNA

Back 18

does not apply

Front 19

HHA

Back 19

home health agency or hospice agency

Front 20

EPSDT

Back 20

early, periodic, screening, diagnosis, and treatment

Front 21

HICN

Back 21

health insurance claim form

Front 22

MCD

Back 22

Medicaid

Front 23

MSP

Back 23

Medicare Secondary Payer

Front 24

NOC

Back 24

not otherwise classified

Front 25

NPP

Back 25

Notice of Privacy Practices

Front 26

OCNA key

Back 26

other carrier name and address key

Front 27

OCR

Back 27

optical character recognition

Front 28

PAYERID

Back 28

payer identification

Front 29

PRO

Back 29

peer review organization or professional review organization

Front 30

TMA

Back 30

Tricare Management Activity