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Med. Insurance Terms

Medical Insurance in a Flash Chapter 12

QuestionAnswer
What is the name of the process for obtaining a qualifying number to determine medical necessity for hospital admissions and surgical procedures? Precertification
What is the place of service code for a physician office? 11
What is the place of service code for outpatient hospital? 22
What is the place of service code for inpatient hospital? 21
What is the place of service code for a skilled nursing facility? 31
What is the place of service code for an ambulatory surgical center? 24
What is the place of service code for custodial care? 33
What is the place of service code for the emergency room of the hospital? 23
What is the approximate time frame for payment to be received from a carrier? 2 weeks
How often should insurance claims be submitted? Daily
In what field do you enter the patient's name on a 1500 form? Item 1
In what field do you enter the patient's gender? Item 3
In what field do you enter the patient's status? Item 8
In what field do you enter the date of current illness? Item 14
In what field do you enter the patient's or authorized person's signature? Item 12
In what field do you enter the name of the referring physician? Item 17
In what field do you enter the prior authoization number? Item 23
In what field do you enter the procedure or service? Item 24d
In what field do you enter the charges? Item 24f
What is the name of the report that is run before the insurance submission? Presubmission Report
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