Health Insurance

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COMB-1

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1958 HIAA and AMA created standardized insurance claim form also known as Attending Physician Signature

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HFCA 1500

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1975 Universal Claim form called Health Insurance Claim Form. AMA joined forces with center for Medicare and Medicaid Services CMS and other payers Uniform Claim Form Task Force standardize and promote their Universal Claim Form

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HCFA-1500 (12-90)

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1990 revised and printed in red ink to allow scanning. By 1992 all Medicare patients from physician had to booked in scannable form

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NUCC

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Mid 1990s the uniform Claim Form task force was replaced by National uniform claim committee to standardize data set for electronic billing to consist with evolving paper Claim Form standards

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CMS-1500

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2001 HCFA-1500 became known as CMS-1500 when the health care finance administration was retitled the Center for Medicare and Medicaid Services CMS

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CMS-1500 (08-05)

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2005 Cms revised 1500-(12-90) to report NPI

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Version 5010 837p

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2009 electronic submission to bill icd10 diagnosis

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1500-(02-12)

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2012 Revised 1500 to implement icd 10 on Claim Form

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02-12 and 08-05

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Jan 2015 clearing house and other vendors accept the newly revised 02-12.

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1500 (08-05)

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April 2014 Claim Form 08-05 was discontinued and only Claim Form 02-12 will be accepted for processing

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Clean claim

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Claim submitted timely and contains all information to process and pay Claim

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Physically Clean Claim

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No staples or highlighted and on which the bar code area has not been deformed

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Rejected Claim

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Claim has not been processed or cannot be processed for various reasons

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Pending claim

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Claim that is held in suspense for review or other reasons by third party payor

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Incomplete claim

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Missing requires information

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Invalid claim

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Medicare claim that contains complete necessary information but is illogical or incorrect for example incorrect provider number

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Dirty claim

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Claim submitted with errors requires manual processing for resolving problem or one rejected payment

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Deleted claim

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Claim canceled, deleted or voided by Medicare

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Omnibus Budget Reconciliation Act (OBRA)

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Medicare administrative contractors to pay prompt payment interest rate on all clean claims