Medical Insurance 7e-A Revenue Cycle Process Approach | Actual 58 Questions and Answers 100%

billing provider - provider of health services reported on a claim, usually a physician practice clean claim - claim accepted by a health plan for adjudication CMS-1500 - Paper claim for physician services HIPAA X12 837 Health Care Claim - electronic form used to send a claim for physician services to primary & secondary payers CMS-1500 (02/12) - current paper claim form approved by NUCC destination payer - In HIPAA claims, the health plan receiving the claim. National Uniform Claim Committee (NUCC) - Organization responsible for the content of health care claims. pay-to provider - entity that will receive payment for a claim rendering provider - healthcare professional who provides health services reported on a claim Place of Service (POS) - administrative code indicating where medical services were provided National Provider Identifier (NPI) - unique ten-digit identifier assigned to each provider-doctors license number subscriber - The insurance policyholder or guarantor for the claimthe NPI is used to report the ___ on a claim - provider identifier list the 5 major actions of the HIPAA claim - 1.Provider 2.Subscriber 3.Payer info 4.Claim details info 5.Services line info EMG - emergency POS - place of service NUCC - National Uniform Claim Committee DDE - Direct Data Entry carve out - part of a standard health plan changed under an employer-sponsored plan