Chapter 1: Claims Submission Flashcards
What is Claims Submission?
The transmission of claims data to payers of processing.
What does the office billing staff codes of?
Diagnosis, procedures and posts the provider’s charges using a computerized billing system.
The billing system may be a component of/
Electronic health record (EHR) or a separate software program.
How is the insurance claimed submitted?
Electronically or paper claim form.
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 Clearinghouse.
What does the provider’s medical billing software creates?
The claims and often submits them in a group at the end of each day.
What is the group named where the provider’s medical billing software submits them?
Batch.
Where the Batch of claims is uploaded?
To the clearinghouse via electronic files.
What reviews the claims for accuracy?
The clearinghouse’s software.
What happens if the analysis reveals incorrect or missing information?
The claim is rejected and returned to the provider.
What happens after the analysis accepts the electronic claims?
The clearinghouse transmits them to the specified payers.
Clean Claims are submitted to carriers for?
Reimbursement.
Does a Clean Claim has errors?
No.
Does Clean Claims is paid upon submission?
Yes.
