Lifecycle Of a Claim Flashcards
The process of checking the details of the claim against the information the third-party payer has on the patient and her/his insurance benefits to determine the amount of payment.
Adjudication
A question made to a third party regarding a claim
Inquiry
The collective information pertaining to a patient and/or claim.
Documentation
The standard form on which all physician’s office claims are filed
CMS-1500
A company that processes, reviews, formats, and distributes claims.
Clearinghouse
An overview of claims recently filed on the patient
Common data file
A process in which a clearinghouse reviews a claim to make sure the information is correct and has been submitted the proper way
Pre-edit
A document listing the patient and claim information and giving an explanation of the benefits covered and payments to be made
Remittance advice
The third-party payer gathers information related to the case ( specifics about the patient, the case, and the coverage.)
Claims processing
Deductible
The amount the policyholder must pay yearly before benefits begin
Is an appeal is disputed, some insurance payers may use a ___.
Peer review
___ are claims that have not yet completed the claims processing cycle.
Open claims
According to Medicare and Medicaid, ___ must be kept for five years.
Claims
Patient will receive an ___ that explains the payments made and the benefits covered.
Explanation of benefits
A ___ is used to assign obligations of payment of unpaid claims to the policy holder
Financial responsibility form
