Question

Name the three selections of the claim form.

Identify the steps for filling a third-party claim.

Differentiate between fraud and abuse.

Answer 1

1.Carrier, patient and insured information, physician or supplier information.

2 The type of insurance should be included in the Section 1 of the claim form. Section 2 of the claim form requires

Insureds ID number, patients full name, patients date of birth and gender, insureds name, patients address and telephone number, patients relationship to insured, insureds address and phone number, secondary insurance name, secondary insurance information, patients condition related to work accident or other, patient release of information, insured authorization of benefits.

Section 3includes date of current illness, whether the patient had sameor similar symptoms, name of referring provider and NPI, from-to dates if the patient encounter included inpatient hospital visit, additional claim information, whether an outside laboratory was used, ICD10CM diagnosis, reference to possible prior Medicaid claim, prior authorization, from -to dates of current encounter, CPT /HCPCS codes, place of service, diagnosis reference, charge amount , NPI of provider, providers EIN or SSN, patients accou number with treating provider, assignment accepted, total charges and address of the facility.

3Fraud is the conscious intent to defraud an entity

Abuse is an inadvertent or unethical action.