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2011-11-13 19:57:49
Chapter 20

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  1. Assignment of Benefits
    The transfer of the patient's legal right to collect benefits for medical expenses to the provider of those services, authorizing the payment to be sent directly to the provider.
  2. Audit
    A process done prior to claims submission to examine claims for accuracy and completeness. An audit can be performed manually or, if computer billing software is used, electronically.
  3. Audit Trail
    The path left by a transaction when it has been completed; often referred to when tracking medical services used by patients or researching claims.
  4. Clean Claims
    Insurance claim forms that have been completed correctly (No errors or omissions) and can be processed and paid promptly if they meets the restriction on covered services and items.
  5. Clearinghouse
    A centralized facility to which insurance claims are transmitted. Clearinghouses seperate, check, and redistribute claims electronically to various insurance carriers and may offer additional services to the physician.
  6. Direct Billing
    A method of electronic claims submission where computer software allows a provider to submit an insurance claim directly to an insurance carrier for payment.
  7. Dirty Claims
    Claims that contain errors or omissions which must be corrected and resubmitted to an insurance carrier in order to obtain reimbursement.
  8. Electronic Claims
    Claims that are submitted to insurance processing facilities using a computerized medium, such as direct data entry, direct wire, dial-in telephone digital fax, or personal computer download or upload.
  9. Electronic Data Interchange (EDI)
    The transfer of data back and forth between two or more entities using an electronic medium.
  10. Electronic (or digital) Signature
    A scanned signature or other such mark that is accepted as proof of approval of and/or responsibility for the content of an electronic document.
  11. Employer Identification Number (EIN)
    The number used by the Internal Revenue Service that identifies a business or individual functioning as a business entity for income tax reporting.
  12. Incomplete Claim
    A claim that is missing information and is returned to the provider for correction and resubmission. This is sometimes also called an invalid claim.
  13. Intelligent Character Recognition (ICR)
    The electronic scanning of printed items as images and use of special software to recognize these images (or characters) as ASCII text for upload into a computer database.
  14. National Provider Identifier (NPI)
    A lifetime numebr consisting of 10 digits that Medicare will use to replace the Provider Identification Number(PIN) and the Unique Physician Identification Number (UPIN)
  15. Paper Claims
    Hard copies of insurance claims that have been completed and sent by surface mail.
  16. Provider
    Any company, individual, or group that provides medical, diagnostic, or treatment services to a patient.
  17. Provider Identification number (PINs)
    Numbers assigned to providers by a carrier for use in submission of claims
  18. Rejected Claims
    Claims returned unpaid to the provider for clarification of any question and that must be corrected before resubmission.
  19. Unique Provider Identification Number (UPIN)
    A number assignedby fiscal intermediaries to identify providers on claims for services
  20. Universal Form
    the form developed by the Health Care Financing Administration (HCFA) (now known as tyhe Centers for Medicare and Medicaid Services (CMS) and approved by the AMA for use in submitting all government sponsored claims, also known as the CMS-1500 form.