Day 8

Question 1

What is meant by sending Corrected Claims?

Answer 1

Sending Corrected Claims means we add 07 code in box no. 22 (Resubmission code) of the claim form.

Question 2

What is NPI?

Answer 2

NPI stands for National Provider Identification. It is a 10 digit character assigned to healthcare provider in USA.

Question 3

What is Tax ID?

Answer 3

It is a 9 digit number for individual tax payers in USA.

Question 4

Taxonomy

Answer 4

It describes the speciality of the Provider.

Question 5

PTAN

Answer 5

PTAN stands for Provider Transaction Access Number. It is used to get claim status from Medicare.

Question 6

Offset

Answer 6

It means for example, a claim expected amount was $500 but the Insurance Company payed $800, so the excess amount of $300 will be adjusted in the next claim.

Question 7

Recoupment

Answer 7

It means a letter is sent by the Insurance Company to the Provider to refund the excess amount.

Question 8

Refund

Answer 8

It means Provider by his end itself credits the excess amount to the Insurance Company.

Question 9

Birthday Rule

Answer 9

For a child when both parents have separate Insurance Policy then whosoever’s Birthday comes first in the calender year, their Insurance will act as a Primary Payor for the Child.

Question 10

Baby Mom Clause

Answer 10

For a new born baby, for the initial 30 days all the medical expenses of the baby will be covered under Mother’s Insurance Plan.

Question 11

Correspondence Letter

Answer 11

It is a letter sent by the Insurance Company/Payor to the Provider or Patient for additional information.

Question 12

How many types of Inclusive are there?

Answer 12

There are 4 types of Inclusive, which are:
1) Incidental Inclusive
2) Bundled Inclusive
3) Mutually Exclusive
4) Global Inclusive