2024 CRCR Modules 3.1-3.9 Questions and Answers ( Included ) 100% Correct
- Claim Processing
Answer: Includes all activities required to send a request for payment to a third-party payer for payment of benefits under an insurance policy.
- Ub-04 form
Answer: STANDARDIZED CLAIM FORM USED BY HOSPITALS
- CMS 1500 form
Answer: Standardized professional service claim form
- Clean claim
Answer: a claim that is sent to a payer either electronically or on paper, that has no defect, impropriety, or particular circumstance requiring special treatment that prevents prompt payment
- Charge master problems
Answer:
- Does not include all charges
- Includes obsolete or invalid codes
- Does not include required modifiers
- Claim Edits
Answer: Rules developed to verify the accuracy and completeness of claims based
on each payer's policies.
- Claim Payers
Answer:
- Medicare
- Medicaid
3. TRICARE
- Indian Health Service (HIS)
- Blue Cross
- Managed Care Plans
- Commercial Indemnity Plans
- Self-Insured Plans
- Liability Claims
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