Introduction to Claims (Claims Department)

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Across
  1. 2. Process for recovering overpayment to a patient or provider
  2. 5. Two-digit codes that provide additional information about a billed procedure
  3. 11. Process of creating a new claim from one previously submitted to record as a duplicate or correct information
  4. 13. Allows Providers to submit electronic attachments with claims
  5. 14. Amount insurance company agreed to pay for procedure or service
  6. 15. Submitted to reverse all or part of a previously filed claim and reinstate Member benefits
  7. 17. Codes used to indicate where in the processing procedure the claim is
  8. 19. Period of time a patient needs to wait before they become eligible for coverage or a specific service under a plan
  9. 21. Codes used to document medical procedures
  10. 22. Used to link a diagnosis code to a service performed
  11. 24. Process of running a claim through a real-time status check
  12. 27. International Classification of Diseases Used to identify reason for patient-physician encounter
  13. 28. Code indicates claim received through clearinghouse
  14. 29. Comprehensive listing of fee maximums used to reimburse providers on a fee-for-service basis
  15. 30. Process of evaluating a claim for payment of benefits
  16. 31. Form providing common format for reporting dental services to a patient’s plan
  17. 32. Company providing electronic submission and translation services between providers and insurance companies
  18. 33. Codes used to explain reasons why a claim was paid or denied
  19. 34. Used by Dental Providers to obtain permission to provide services prior to them being rendered
  20. 35. Replacement of a previously submitted claim to fix incorrect or missing information
Down
  1. 1. Submitted by Providers to receive authorization to perform services prior to those services being rendered
  2. 3. Amount a patient owes a provider after the insurance company has paid their portion of a claim
  3. 4. Form used to submit claims for vision services to a patient’s plan
  4. 6. Any claim submitted by a provider for the same service provided to a patient on a specified date that was included in a previously submitted claim
  5. 7. Used by Vision and Hearing Providers to obtain permission to provide services prior to them being rendered
  6. 8. Any specific situation, condition, or treatment that a health insurance plan does not cover
  7. 9. Codes used to document dental treatment
  8. 10. Date the claim or pre-authorization is settled by claims
  9. 12. Codes used to group and identify diseases, disorders, symptoms, etc.
  10. 16. Internal clearinghouse used by Avēsis
  11. 18. Person who decides whether a patient’s insurance policy covers a medical procedure
  12. 20. Electronic claim form
  13. 23. Payment statement sent to provider after a claim is processed (aka Remittance Advice)
  14. 25. Coverage options that enable a patient to expand basic insurance plan for an additional premium
  15. 26. Avēsis department that processes pre-authorization for dental, vision, or hearing services
  16. 36. Benefits statement sent to member and provider after a claim is processed