Describe How The Patient'S Insurance Eligibility Is Confirmed
Question: The process of obtaining the dollar amount approved for a medical procedure or service before the procedure or service is scheduled.
Answer: Precertification
Question: Obtained from health insurance companies and gives the provider approval to render the medical service.
Answer: Preauthorization
Question: The electronic transfer of data (e.g. electronic claims) between two or more entities.
Answer: Electronic data interchange
Question: A process done prior to claims submission to examine claims for accuracy and completeness.
Answer: Audit
Question: A contract between a provider and an insurance company in which the health plan pays a monthly fee per patient while the provider accepts the patient’s copay as payment in full for office visits.
Answer: Capitation agreements
Question: The process of obtaining the dollar amount approved for a medical procedure or service before it is scheduled.
Answer: Precertification
Question: Form used by most health insurance payers for claims submitted by providers and suppliers.
Answer: CMS-1500
Question: Process by which an insurance carrier allows a provider to submit insurance claims directly to the carrier electronically.
Answer: Direct billing
Question: A healthcare provider who has signed a contract with a health insurance plan to accept lower reimbursements for services in return for patient referrals.
Answer: Participating provider
Question: An intermediary that accepts the electronic claim from the provider, reformats the claim to the specifications outlined by the insurance plan, and submits claim.
Answer: Claims clearinghouse