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Assignment of benefits
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The transfer of the patient's legal right to collect benefits for medical expenses to the provider of those services, authorizing the payment to be sent directly to the provider.
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Audit
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A process done prior to claims submission to examine claims for accuracy and completeness. An audit can be performed manually or, if computer billing software isused, electronically.
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Audit trail
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The path left by a transaction when it has been completed; often referred to when tracking medical services used by patients or researching claims.
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Clean claims
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Insurance claim forms that have been completed correctly (no errors or omissions) and cann be processed and paid promptly if they meets the restrictions on covered services and items.
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Clearinghouse
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A centralized facility to which insurance claims are transmitted. Clearing houses separate, check and redistribute claims electronically to various insurance carriers and may offer additional services to the physician.
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Direct billing
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A method of electronic claims submission where computer software allows a provider to submit an insurance claim directly to an insurace carrier for payment
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Dirty claims
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Claims that contain errors omissions which must be corrected and resubmitted to an insurance carrier in order to obtain reimbursement
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Electronic claims
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Claims that are submitted to insurance processing facilities using a computerized medium. such as direct data entry, direct wire, dial-in telephone digital fax, or personal computer download or up load.
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Electronic Data Interchange (EDI)
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The transfer of data back and forth between two or more entities using an electronic medium
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Electronic ( or digital) signature.
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A scanned signature or other such mark that is accepted as proof of approval of and/or responsibility for the content of an electronic document
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Employer identification number (EIN)
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The number used by the Internal REvenue Service that identifies a business or individual functioning as a business entity for income tax reporting.
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Incomplete claim
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A claim that is missing information and is returned to the provider for correction and resubmission. this is sometimes also called an invalid claim
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Intelligent Character Identifier (ICR)
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The electronic scanning of printed items as images and use of special software to recognize these images (or characters) as ASCII text for upload into a computer database
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National Provider Identifier (NPI)
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A lifetime number consisting of 10 digits that Medicare will use to replace the Provider Identification Number (PIN) and the Unique Physician Identification Number (UPIN)
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Paper claims
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Hard copies of insurance claims that have been completed and sent by surface mail.
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