Claim Management and Posting Payments and Creating Statements
Chapter 13 and 14 learning fun
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Topics of this game:
- health plans rules specifying the number of days after the date of service that the practice has to file the claim
- a condition that data must meet to be selected
- company that processes electronic health information and executes electronic transactions such as insurance verification and claim submissions
- a claim that has no edits and can go directly to the payer
- claim billed to Medicare and then submitted to Medicaid
- series of steps that determine whether a claim should be paid
- claim status when the payer is developing the claim
- process of gathering information to adjudicate a claim
- payers decision about the benefits due for a claim
- request for reconsideration of a claim adjudication
- person or entity exercising the right to receive benefits
- person who appeals a claim decision
- formal examination or review, such as a review to determine whether an entity is complying with regulations
- improper or excessive amount received by provider from payer
- balance that a provider owes a payer following a post payment audit
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