Computer Software Applications Chapter 10

Front 1

Timely filing

Back 1

Health plans rules specifying the number of days after the date of service that the practice has to file the claim

Front 2

HIPAA X 12 837 Healthcare claim

Back 2

HIPAA standard format for electronic transmission of the claim to a health plan

Front 3

CMS- 1500 (08/05)

Back 3

The mandated paper insurance claim form

Front 4

National uniform claim committee(NUCC)

Back 4

Organisation responsible for claim content

Front 5

Data elements

Back 5

Smallest unit of information in a HIPAA transaction

Front 6

Filter

Back 6

A condition that data must need to be selected

Front 7

Companion guide

Back 7

Guide published by a payer list its own set of claim edits and formatting conventions

Front 8

Cross over claims

Back 8

Claim bill to Medicare and then submitted to Medicaid

Front 9

Ad junctions

Back 9

Series of steps that determine whether a claim should be paid

Front 10

Suspended

Back 10

Claim status when the paper is developing claim

Front 11

Development

Back 11

Process of gathering information to adjusticate a claim

Front 12

Determination

Back 12

payer's decision about the benefits due for a claim

Front 13

Medical necessity denial

Back 13

Refused by a plan to pay for a procedure that does not meet its medical necessity criteria

Front 14

Prompt payment laws

Back 14

State laws that mandate a time period within which clean claims must be paid if they are not financial penalties are levied against the payer

Front 15

Claim turnaround time

Back 15

Time period in which a health plan must process a claim

Front 16

aging

Back 16

Classification of accounts receivable by length of time

Front 17

Insurance aging report

Back 17

Report that list how long a payer has taken to respond to insurance claims

Front 18

HIPAA X12 276/277 health care claim status inquiry/response

Back 18

Electronic format used to ask payers about claims

Front 19

Claim status category codes

Back 19

used to report the status group for a claim

Front 20

Pending

Back 20

Claim status in which the payer is waiting for information before making a payment decision

Front 21

Claim status codes

Back 21

You to provide a detailed answer to a claim status inquiry