Insurance Handbook for the Medical Office 13 th edition. Chapter 08 The Electronic Claim. Electronic Claims Submission Overview. Define electronic data interchange . Summarize the advantages of electronic claim submission.
The Electronic Claim
Define electronic data interchange.
Summarize the advantages of electronic claim submission.
Describe the clearinghouse process that follows after a claim is electronically received.
Identify the transactions and code sets to use for insurance claim transmission.
State which insurance claim data elements are required or situational for the 837P standard transaction format.
Define a claim attachment, and explain when the electronic standards will be mandated.
Compare and contrast standard unique provider identifiers, health plan identifiers, and patient identifiers.
Describe necessary components when adopting a practice management system.
Describe the use of patient encounter forms and scannable encounter forms in electronic claim submission.
Name some methods of interactive computer transactions for transmitting insurance claims.
Relate the electronic funds transfer process and mandated requirements under the Affordable Care Act (ACA).
Identify the ASC X12 Health Care Claim Payment/Advice (835).
List the procedures for transmission of an electronic claim.
Explain the difference between carrier-direct and clearinghouse electronically transmitted insurance claims.
List computer transmission problems that can occur.
List HIPAA administrative safeguards for electronic protected health information.
State technical and physical safeguards used to secure privacy of e-mail, Internet, and instant messaging.
Explain handling of data storage and data disposal for good electronic records management.
Describe elements that should be considered when purchasing an in-office computer system.