Chapter 27

1. claim scrubbing ensures that claims are correctly coded before being sent to the insurance company, which reduces denials and increases payments to the practice
2. a private or public company that often serves as the middleman between physicians and billing groups, payers, and other health care partners for the transmission and translation of electronic claims information into the specific format required by payers.
3. refers to the exchange of routine business transactions from one computer to another in a standard format
4. the name of the standard unique health identifier for health care providers.
6. the federal agency within the U.S. Department of Health and Human Services
7. claim that is automatically forwarded from Medicare to a secondary insurer after Medicare has paid its portion of a service.
8. computer software designed for monitoring insurance claims.

1. exists when a patient is covered under more than one insurance plan; charges are first submitted to the primary carrier, and any charges not covered are then submitted to the secondary carrier.
3. a flat file format used to transmit or transport claims.
5. signed into law on December 27, 2001, as Public Law 107-105.