Chapter 1: Claims Submission Flashcards

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1
Q

What is Claims Submission?

A

The transmission of claims data to payers of processing.

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2
Q

What does the office billing staff codes of?

A

Diagnosis, procedures and posts the provider’s charges using a computerized billing system.

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3
Q

The billing system may be a component of/

A

Electronic health record (EHR) or a separate software program.

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4
Q

How is the insurance claimed submitted?

A

Electronically or paper claim form.

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5
Q

What acts as the go-between in the claims, submission process, making it easier for providers to submit claims to many different insurance carriers?

A

A Clearinghouse.

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6
Q

What does the provider’s medical billing software creates?

A

The claims and often submits them in a group at the end of each day.

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7
Q

What is the group named where the provider’s medical billing software submits them?

A

Batch.

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8
Q

Where the Batch of claims is uploaded?

A

To the clearinghouse via electronic files.

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9
Q

What reviews the claims for accuracy?

A

The clearinghouse’s software.

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10
Q

What happens if the analysis reveals incorrect or missing information?

A

The claim is rejected and returned to the provider.

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11
Q

What happens after the analysis accepts the electronic claims?

A

The clearinghouse transmits them to the specified payers.

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12
Q

Clean Claims are submitted to carriers for?

A

Reimbursement.

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13
Q

Does a Clean Claim has errors?

A

No.

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14
Q

Does Clean Claims is paid upon submission?

A

Yes.

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