Question

In the cases that follow, you play the role of a medical insurance specialist who is preparing HIPAA claims for transmission. Assume that you are working with the practice’s PMP to enter the transactions. The information you enter is based on the patient information form and the encounter form.

    •    Claim control numbers are created by adding the eight-digit date to the patient account number, as in AA026-10042029.

    •    A copayment of $15 is collected from each Oxford PPO patient at the time of the visit. A copayment of $10 is collected for Oxford HMO.

Provider Information

 

Billing Provider Valley Associates, PC NPI 1476543215

Address 1400 West Center Street, Toledo, OH 43601-0213

Telephone 555-967-0303

Employer ID Number 16-1234567

Rendering Provider Christopher M. Connolly, MD

NPI 8877365552

Oxford PPO Provider Number 1011

Oxford HMO Provider Number 2567

Assignment Accepts

Name Jennifer Porcelli

Sex Female

Birth Date 07/05/1982

Marital Status Married

Address 310 Sussex Turnpike, Shaker Heights, OH 44118-2345

Telephone 555-709-0388

Employer 24/7 Inc.

Race White

Ethnicity Not Hispanic or Latino

Preferred Language English

Insured Self

Health Plan Oxford Freedom PPO

Insurance ID Number 712340808X

Policy Number 6529436

Group Number G0119

Copayment/Deductible Amount $15 copay

Assignment of Benefits Y

Signature on File 01/01/2029

Condition Unrelated to Employment, Auto Accident, or Other Accident

A. What procedure code(s) is (are) being billed on the claim?

B. List the name and the primary identification number of the billing provider for this claim.

C. Are the subscriber and the patient the same person?

D. What copayment is collected?

E. What amount is being billed on the claim?

Answer 1

A. procedure code 99212

B. Christopher M. Connolly, M.D.: NPI 8760399261

C. Yes

D. $15

E. $46