Processing A Health Insurance Claim

26/40

What would be the next appropriate steps for Dr. Helper's office to take regarding a claim with the denial code 005?

Appeal the claim by sending a letter with supporting documentation

Based on the provided case study what information in block 1a?

XWN212567972

In which block on the CMS 1500 form would ICD codes indicating the patient's diagnosis for this encounter be placed?

21

The provision in health insurance policies that specifies in what SEQUENCE coverage will be provided when more than one policy covers the claim is

coordination of benefits

Identify the allowed amount for procedure 99212.

$34

You are reviewing a remittance advice from a payer.  Which of the following is the next appropriate step to correct a REJECTED claim?

Review the reason code to resolve the issue

A public/private entity that processes  or "scrubs" insurance claims before they are submitted to the insurance company is called a  

clearinghouse

When is a bill for secondary insurance coverage generated?

After the payment is received from the primary insurer