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insurance
| Question | Answer |
|---|---|
| A exchange of data in a standardize format through computer systems. (health insurance claims) | electonic data exchange |
| A coding system that makes data of health recordes look like gibberish so that if it is sent to the wrong place it is unable to be read. If sent to right place they have the software to code and read it. | encryption |
| An entity that receives the electronic transmission of claims from the health care provider's office and translates it into a standard format prescribed in HIPAA regulations. | clearinghouses |
| What codes are defined as the science of classification made of numeric and alpha provider specialty codes which are assigned and which classify each health care provider. | taxonomy codes |
| What developed the US standards body for the cross-industry development, maintence, and publication of electronic data exchange standards. | accredited standards committee x12 (ASC X12) |
| A standard for a uniform patient identifier that is on hold because ob the protest of the people who see it as a civil libertie threat. | standard unique identifer |
| An add-on software to practice management system that can greatly reduce time it takes to build or review a claim, it prompts a series of quistions or choices to edite a claim. | encoder |
| A computerized system that enables funds to be debited, credited, or transfurred and eliminates the need for personal handling of checks. | electronic funds transfer (EFT) |
| online transaction about the status of a claim is called | electronic remittance advice (ERA) |
| An interactive back-and-forth communication between two computers where one request info and the other provides info during what is referred to as online | real time |
| Keying claim info derectly into the payers system by accessing over modem dial up or DSL is called | direct data entry (DDE) |
| What prevents unauthorized use or disclosure of phi through administrative actions that manage the selection, development, implementation, and maintenance of security measures to protect ephi. | administrative safeguards |
| What are technologic controls in place to protect and control access to info on computers in the health care organization and controls who can access by job category with individual passwords. | technical safeguard |
| What prevents unauthorized access to a phi of media and equepment or other in office protection to prevent any access or heard phi. | physical safeguard |
| This is a group of claims for different patients sent at the same time from one facility. | batch |
| This is a chronologic record of submitted data that can be traced to the source to determine the place of origin. | audit trail |
| What was developed to achieve a higher quality of care and to reduce administrative and financial transactions. | transaction and code set rule (TCS) |
| This report list each patients name, total charges for medical services, batch number, billing number, name of insurance company billed,and chronologically the date the claim was transmitted. | batch claim report billed summary |
| This report shows that a file is received by the clearinghouse and or payer and also notifies the billing specialist when a file has been sent to the providers account for review. | send and receive files reports |
| What report indicates the total number of claims, charges, and dollar amounts that were received by the clearinghouse and scrubbed for claim submitted to and insurance company | scrubber report |
| What report shows how many claims were originally recived by the clearinghouse and or payer and how many claims were rejected automatically. | transaction transmission summary |
| This report identifies the most common reasons claims are rejected and indicates what claims were not included for processing. | rejection analysis report |
| This report lists files received form the providers office and indicates the progress of the claim. | electronic inquiry or claims status review |
| When renting a practice management system availavle over the internet all sata is housed on the this bor the accounts are managed by the health care providers staff. | application service provider ASP |
| asp | application service provider |
| tcs | transaction and code set rules |
| dde | direct data entry |
| era | electronic remittance advice |
| eft | electronic funds transfer |
| edi | electronic data interchange |
| What is medical code sets used uniformly to document why patients are seen and what is done to them during their encounter. | data elements |
| These are an allowable set of codes that anyone can use to enter into a specific space on a form | code sets |
| A vendor agreement between the clearinghouse and a provider submitting the claims is called | business associate agreement, trading partner, or other contract. |
Created by:
maryce
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