Question

chapter 7 review policyholder must spend on medical services before benefits begin. ype of managed care system in which providers are paid fixed rates at regular Intervals. ims with all the correct information necessary for payer processing. L The mandated paper insurance claim form. n. Healthca re clai o. Healthcare services that are reasonable, necessary, and/or appropriate evidence-based clinical standards of care CHECKING YOUR UNDERSTANDING 16. ILO 7.SI A claim needs to you select only be submitted for John Fitzwilliams. How would those claims pertaining to John Fitzwilliams? 17. (LO 7.61 If an error is found on a claim, how is it correctedr 18. LO 72) What is meant by a "clean claim"? 19. ILO 72) What is HIPAA X12 837 20. ILO 25 What is the List Only feature in the Claim Management dialog box used for? 21. ILO 29) In Medisoft, where is information about electronic claim attachments entered? APPLYING YOUR KNOWLEDGE ILO 241 You are asked to create a claim for Samuel Bell. After entering his chart number n the Create Claims dialog box, you receive the message "No new claims were created." Why were no claims created for Samuel Bell? 23. ILO 241 How would you create claims for one specific insurance carrier 24, /L。7 You are not sure whether an electronic claim for a particular patient was transmitted. How would you find out? 25. ILO 7.9) A new billing specialist in the office tells you it is less costly to submit electronic claims directly to insurance carriers without using a clearinghouse. Why do you think offices use clearinghouses? What are the benefits? 26. ILO 72) If claims were not created and transmitted, what would the consequence bei? 27. ILo z21 Why is it important that claims be submited soon after the patient's visit? 28. ILO 7.2) Why is it important that claims be submitted with complete and correct information? Enhance your learning by and more at CIMO PART 2 MEDISOFT ADVANCED TRAINING

Answer 1

Q. No. 17. Answer :

If an error found in a claim, we should correct like  

On hold section of the claim manager, we need to double click on the any where on the claim line patient to open patient account or information.

* then next patient account will show the claims tab, like active claim on the bottom section,

* so corrections can be made by clicking on the client account do the corrections, then save those corrections by clicking on save button.

* Then submit those corrected claim.

Like this we need to do a corrections on error claim.

Q. No. 18. Answer :

Clean claim :

It is defined as it is a claim which is not having any defects, and special circumstances, and improperness, that means incomplete documentation or the reports which will delay the payments is called clean claim.

Which means clear documentation or information.

Q. No. 19. Answer :

HIPAA : Health insurance portability and accountability act.

HIPAA X 12 it is a set of standards or rules and regulations to maintain the electronic transmission of particular health care transactions, which includes eligibility and claim satus, and it's referrals.

HIPAA 837 is an electronic file which contains the patient related claim information and this file is submitted like that only to the insurence purpose to an insurance company and or to the billing clearing purpose, with out printing a paper or mailing, it is called as HIPPA 837.

Q. No. 21. Answer :

The electronic claim information attached in the medisoft, EDI report section of the diagnosis tab. There are some fields includes report type code and report transmission code attachments control codes ect.