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After reading Chapter Electronic Claims, you will complete an outline of the outcomes. Your outline should be organized and concise. Outcomes: Describe an electronic claim.
After reading Chapter Electronic Claims, you will complete an outline of the outcomes. Your outline should be organized and concise.
Outcomes:
- Describe an electronic claim.
- Define and discuss electronic data interchange.
- Describe necessary components when adopting an accounts receivable management or computerized medical billing system.
- Explain the difference between carrier-direct and clearinghouse electronically transmitted insurance claims.
- Summarize the advantages of electronic claim submission.
- Identify the transactions and code sets to use for insurance claims transmission.
- Discuss the difference between insurance claim data elements which are required or situational for the 837P standard transaction format.
- Define a claim attachment and discuss claim attachments standards.
- Compare and contrast standard unique provider identifiers, health plan identifiers, and patient identifiers.
- Name and discuss some methods of interactive computer transactions for transmitting insurance claims.
- Discuss interactive transactions and relate the electronic funds transfer process and mandated requirements under the Affordable Care Act (ACA).
- Define an electronic remittance advice and identify the ACS X12 Health Care Claim Payment/Advice (835).
- Identify transmission reports generated to track the electronic claims process.
- List computer transmission problems that can occur.
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