OST 148 Ch. 7 Key Terms

billing provider

entity that is sending the claim to the payer

clean claim

claim accepted by a health plan for adjudication

destination payer

insurance carrier that is to receive the claim

line-item control number

unique number assigned by the sender to each service line on a claim

pay to provider

entity that is to receive payment for the claim

POS code

stands for the type of facility in which services reported on the claim were provided

claim scrubber

software used to check claims

rendering provider

provider of healthcare services reported on a claim

subscriber

the insurance policyholder or guarantor for the claim

healthcare provider taxonomy code (HPTC)

stands for the type of provider specialty

carrier block

the data entry area in the upper right portion of the CMS-1500

CMS-1500

paper claim for physician services