Chapter 15 The Electronic
Claim questions and answers
(graded A+)
Accredited Standards Committee X12 (ASC X12) - answerThe United
States standards body formed by the American national Standards
Institute for cross-industry development, maintenance and
publication of electronic data exchange standards
ASCX12 Version 5010 - answerSystem developed by the American
national Standards Institute that meets HIPAA standards for the
transmission of either ICD-9 or ICD-10 diagnostic code data
Administrative Simplification Enforcement Tool - answera web-based
tool implemented by the federal government to address issues of
non-compliance with the HIPAA by enabling health care providers,
payers, clearinghouses and others to submit complaints against a
covered entity that fails to adopt and follow the HIPAA rules for
transactions and code sets
American National Standards Institute (ANSI) - answerA private,
non-profit organization that coordinates the development and use of
a voluntary consensus standards in the United States.
Application service provider - answerA practice management system
available over the internet in which data are housed on the server
of the ASP but the accounts are managed by the health care
provider's staff
Audit trail - answerChronologic record of submitted data that can be
traced to the source to determine the place or origin. Also referred
to as Audit Log
, batch - answergroup of claims for different patients from one office
submitted in one computer transmission
cable modem - answermodem used to connect a computer to a cable
television system that offers online services
carrier-direct system - answerA method for submission of claims in
which data is transmitted electronically directly to the payer's
system, without the need for a clearing house
Claim attachments - answerDocuments that contain information,
hard copy or electronic, related to a completed insurance claim that
assists in validating the medical necessity or explains the medical
service or procedure for payment (e.g., operative report, discharge
summary, invoice).
clearinghouse - answerAn independent organization that receives
insurance claims from the physician's office, performs software
edits, and redistributes the claims electronically to various
insurance carriers.
covered entity - answeran entity that transmits health information
in electronic form in connection with a transaction covered by HIPAA
code sets - answerAny set of codes with their descriptions used to
encode data elements such as tables of terms, medical concepts,
medical diagnostic codes, or medical procedure codes.
data elements - answerMedical code sets used uniformly to
document why patients are seen (diagnosis, ICD-9-CM) and what is
done to them during their encounter (procedure, CPT-4, HCPCS)
Claim questions and answers
(graded A+)
Accredited Standards Committee X12 (ASC X12) - answerThe United
States standards body formed by the American national Standards
Institute for cross-industry development, maintenance and
publication of electronic data exchange standards
ASCX12 Version 5010 - answerSystem developed by the American
national Standards Institute that meets HIPAA standards for the
transmission of either ICD-9 or ICD-10 diagnostic code data
Administrative Simplification Enforcement Tool - answera web-based
tool implemented by the federal government to address issues of
non-compliance with the HIPAA by enabling health care providers,
payers, clearinghouses and others to submit complaints against a
covered entity that fails to adopt and follow the HIPAA rules for
transactions and code sets
American National Standards Institute (ANSI) - answerA private,
non-profit organization that coordinates the development and use of
a voluntary consensus standards in the United States.
Application service provider - answerA practice management system
available over the internet in which data are housed on the server
of the ASP but the accounts are managed by the health care
provider's staff
Audit trail - answerChronologic record of submitted data that can be
traced to the source to determine the place or origin. Also referred
to as Audit Log
, batch - answergroup of claims for different patients from one office
submitted in one computer transmission
cable modem - answermodem used to connect a computer to a cable
television system that offers online services
carrier-direct system - answerA method for submission of claims in
which data is transmitted electronically directly to the payer's
system, without the need for a clearing house
Claim attachments - answerDocuments that contain information,
hard copy or electronic, related to a completed insurance claim that
assists in validating the medical necessity or explains the medical
service or procedure for payment (e.g., operative report, discharge
summary, invoice).
clearinghouse - answerAn independent organization that receives
insurance claims from the physician's office, performs software
edits, and redistributes the claims electronically to various
insurance carriers.
covered entity - answeran entity that transmits health information
in electronic form in connection with a transaction covered by HIPAA
code sets - answerAny set of codes with their descriptions used to
encode data elements such as tables of terms, medical concepts,
medical diagnostic codes, or medical procedure codes.
data elements - answerMedical code sets used uniformly to
document why patients are seen (diagnosis, ICD-9-CM) and what is
done to them during their encounter (procedure, CPT-4, HCPCS)
