1 Inquire through: | Professional | Confidential Support
UHB chapter 10 Questions and Answers (100%
Correct Answers)
insurance claim form
Ans: a form that is completed by providers for the purpose of submitting charges
for medical services and supplies to various third-party payers.
Claim forms contain
Ans: fields for recording data about the provider, insured, date of service, and
charges
provider
Ans: an individual or entity that provides medical services/supplies to patients ex:
physician, physician assistant, nurse practitioner, clinic, laboratory, radiology,
hospital and ambulatory surgery center
reimbursement
Ans: the payment received from a third-party payer for services rendered by the
provider to a patient which is determined based on the information reported on the
claim form.
manual claim submission
Ans: paper claim that is typed or computer generated on paper and sent by mail.
Advantages: ability to review the claim before submission
Disadvantages: No tracking, can be lost in the mail, no proof of receipt to say when
the payer received the claim, unless using registered or certified mail, which is
expensive, longer processing time, which results in delayed reimbursement.
electronic media claim (EMC)
Ans: claim that is transmitted through electronic data interchange
electric data interchange (EDI)
Ans: process of sending data from one computer to another by telephone line or
cable
optical character recognition (OCR)
Ans: The ability of a scanning device to recognize handwritten or typed characters
and convert them to electronic form as text, not images.
optical scanning
Ans: process where the claim form is scanned and the data is transferred into a
computer system. Claim forms are outlined in red, which allows the scanner to pick
up only data in the fields.
, 2 Inquire through: | Professional | Confidential Support
non compliance
Ans: most payers require electronic submission of claims. Providers who are not
equipped to submit electronic claims will not be in compliance with these payer
guidelines.
The purpose of claim forms is to submit charges for medical services and supplies to
various third-party payers for reimbursement.
Ans: True
Third-party reimbursement for medical services and/or supplies is determined based
on the information reported on the claim.
Ans: True
A computer template defines all the information required on the claim for the payer,
and specific payer edits can also be programmed.
Ans: TRUE
Manual submission of claims results in reduced processing time. Reimbursement for
manual claims may be generally received within 7 to 14 days.
Ans: False
The CMS-1450 (UB-04) is used by non-institutional providers to submit professional
charges for physician and outpatient services to payers for reimbursement.
Ans: False
Claim forms can be submitted to third-party payers _______ on paper or by _______.
Ans: MANUALLY, ELECTRONIC TRANSMISSION
Two claim forms that are used for submission of claims to payers are the
_________and the _____________.
Ans: CMS-1500, CMS-1450 (UB-04)
The electronic claims process can be accomplished by ______ transmission or
transmission through a ____________.
Ans: direct, clearinghouse.
A ________ is an organization that reformats claim data received from various
providers to meet compatibility specifications for various payers.
Ans: clearinghouse
The standard transaction format for the CMS-1500 is the ______ and the format for
the CMS-1450 (UB-04) is the ______.
Ans: ANSI X12 837, ANSI X12 8371
Claim form used by institutional providers to submit hospital facility charges for
services, procedures, and items to payers for reimbursement.
Ans: CMS-1450
UHB chapter 10 Questions and Answers (100%
Correct Answers)
insurance claim form
Ans: a form that is completed by providers for the purpose of submitting charges
for medical services and supplies to various third-party payers.
Claim forms contain
Ans: fields for recording data about the provider, insured, date of service, and
charges
provider
Ans: an individual or entity that provides medical services/supplies to patients ex:
physician, physician assistant, nurse practitioner, clinic, laboratory, radiology,
hospital and ambulatory surgery center
reimbursement
Ans: the payment received from a third-party payer for services rendered by the
provider to a patient which is determined based on the information reported on the
claim form.
manual claim submission
Ans: paper claim that is typed or computer generated on paper and sent by mail.
Advantages: ability to review the claim before submission
Disadvantages: No tracking, can be lost in the mail, no proof of receipt to say when
the payer received the claim, unless using registered or certified mail, which is
expensive, longer processing time, which results in delayed reimbursement.
electronic media claim (EMC)
Ans: claim that is transmitted through electronic data interchange
electric data interchange (EDI)
Ans: process of sending data from one computer to another by telephone line or
cable
optical character recognition (OCR)
Ans: The ability of a scanning device to recognize handwritten or typed characters
and convert them to electronic form as text, not images.
optical scanning
Ans: process where the claim form is scanned and the data is transferred into a
computer system. Claim forms are outlined in red, which allows the scanner to pick
up only data in the fields.
, 2 Inquire through: | Professional | Confidential Support
non compliance
Ans: most payers require electronic submission of claims. Providers who are not
equipped to submit electronic claims will not be in compliance with these payer
guidelines.
The purpose of claim forms is to submit charges for medical services and supplies to
various third-party payers for reimbursement.
Ans: True
Third-party reimbursement for medical services and/or supplies is determined based
on the information reported on the claim.
Ans: True
A computer template defines all the information required on the claim for the payer,
and specific payer edits can also be programmed.
Ans: TRUE
Manual submission of claims results in reduced processing time. Reimbursement for
manual claims may be generally received within 7 to 14 days.
Ans: False
The CMS-1450 (UB-04) is used by non-institutional providers to submit professional
charges for physician and outpatient services to payers for reimbursement.
Ans: False
Claim forms can be submitted to third-party payers _______ on paper or by _______.
Ans: MANUALLY, ELECTRONIC TRANSMISSION
Two claim forms that are used for submission of claims to payers are the
_________and the _____________.
Ans: CMS-1500, CMS-1450 (UB-04)
The electronic claims process can be accomplished by ______ transmission or
transmission through a ____________.
Ans: direct, clearinghouse.
A ________ is an organization that reformats claim data received from various
providers to meet compatibility specifications for various payers.
Ans: clearinghouse
The standard transaction format for the CMS-1500 is the ______ and the format for
the CMS-1450 (UB-04) is the ______.
Ans: ANSI X12 837, ANSI X12 8371
Claim form used by institutional providers to submit hospital facility charges for
services, procedures, and items to payers for reimbursement.
Ans: CMS-1450
