Prentice Hall

Allied Health



The Practice of Health Claims Examining, 2/E
ICDC Publishing, Inc.

ISBN-10: 0132193892
ISBN-13: 9780132193894

Publisher: Prentice Hall
Copyright: 2007
Format: Paper; 300 pp
Published: 10/11/2006

Suggested retail price: $50.60
Buy from myPearsonStore

Formally known as Exercises in Health Claims Examining, The Practice of Health Claims Examining, 2e, contains a simulated work program to help you experience the real life situations that a claims examiner experiences on a daily basis. This book is created for use in conjunction with ICDC Publishing's Guide to Health Claims Examining. Some of the exercises in the simulated work portion of the book are based upon concepts learned in the Guide to Health Claims Examining (i.e., procedures for processing claims, interpretation of contracts, understanding UCR and deductibles, etc.). This book alone should not be considered a complete text for learning health claims examining. It is suggested that a trainee take a complete health claims examining course prior to using this book. The simulated work portion of this text incorporates concepts which are not taught by simple data entry, for example UCR calculations, privacy guidelines, client record keeping, correspondence, and manual completion of claims processing. This text is designed to allow the student to work through the material at their own pace.

 

Table Of Contents

 

 

Section 1. Introduction

 

Let’s Begin

Setting Up Your Desk

Family Files

 

Section 2. Simulated Work Program

 

About the Claims 5

Day   1 — April 1, CCYY

Day   2 — April 2, CCYY

Day   3 — April 3, CCYY

Day   4 — April 4, CCYY

Day   5 — April 5, CCYY

 

Section 3. Documents

 

Document     1 — Confidential Disclosure Agreement

Document     2 — Time Sheet

Document     3 — Ball Insurance Carriers Contract

Document     4 — Rover Insurers Inc. Contract

Document     5 — Winter Insurance Corporation Contract

Document     6 — Summer Insurance Company Contract

Document     7 — Assistant Surgeon’s List

Document     8 — Eligibility Information Sheet (Dunnitt, D. Jobb)

Document     9 — Eligibility Information Sheet (Poole, Gene)

Document   10 — Eligibility Roster /Ball Insurance Carriers (January)

Document   11 — Eligibility Roster/Ball Insurance Carriers (February)

Document   12 — Eligibility Information Sheet (Allity, Ray)

Document   13 — Eligibility Roster/Winter Insurance Carriers (March)

Document   14 — Eligibility Information Sheet (Waite, Hugh)

Document   15 — Eligibility Roster/Winter Insurance Carriers (January)

Document   16 — Relative Value Study

Document   17 — Eligibility Information Sheet (O’Gen, Pat N.)

Document   18 — Eligibility Roster/Rover Insurers, Inc. (January)

Document   19 — Eligibility Information Sheet (Pendent, Codie)

Document   20 — Network Provider Listing/Rover Insurers, Inc. (February)

Document   21 — Eligibility Information Sheet (Attricks, Sherry)

Document   22 — Eligibility Roster/Rover Insurers, Inc. (March)

Document   23 — Eligibility Roster/Winter Insurance Carriers (February)

Document   24 — Eligibility Information Sheet (Knose, Al Weighs)

Document   25 — Beginning Financials

Document   26 — Eligibility Information Sheet (Theroad, Kent C.)

Document   27 — Network Provider Listing/Rover Insurers, Inc. (January)

Document   28 — Eligibility Information Sheet (Cupp, Hick)

Document   29 — Eligibility Roster/Rover Insurers, Inc. (February)

Document   30 — Eligibility Information Sheet (Early, Brighton)

Document   31 — UCR Conversion Factor Report Medical

Document   32 — Eligibility Information Sheet (Fever, Cab N.)

Document   33 — Eligibility Information Sheet (Hart, Shay Kee)

Document   34 — Eligibility Roster/Ball Insurance Carriers (March)

Document   35 — Eligibility Information Sheet (Fraide, B.A.)

Document   36 — Network Provider Listing/Rover Insurers, Inc. (March)

Document   37 — CMS-1500: O’Gen, Ox

Document   38 — CMS-1500: Attricks, Petey

Document   39 — CMS-1500: Attricks, Petey

Document   40 — CMS-1500: Pendent, Dee

Document   41 — CMS-1500: Dunnitt, D. Jobb

Document   42 — Revised Eligibility Roster /Winter Insurance Carriers (January)

Document   43 — Revised Eligibility Roster /Ball Insurance Carriers (January)

Document   44 — Ball Insurance Carriers: Memo

Document   45 — CMS-1500: Allity, Mort

Document   46 — CMS-1500: Poole, Carla

Document   47 — CMS-1500: Knose, Ima

Document   48 — CMS-1500: Knose, Ron E.

Document   49 — CMS-1500: Poole, Gene

Document   50 — Note from Mr. B. Lawg

Document   51 — Family Benefits Tracking Sheet

Document   52 — CMS-1500: Pendent, Dee

Document   53 — CMS-1500: Theroad, Kent C.

Document   54 — CMS-1500: Tired, Barry

Document   55 — CMS-1500: Dunnitt, V. Iris

Document   56 — CMS-1500: Fever, Ty Phoid

Document   57 — CMS-1500: Pendent, Codie

Document   58 — CMS-1500: Akenja-Nearing, Jeanette

Document   59 — CMS-1500: Knose, Ron E.

Document   60 — CMS-1500: Allity, Mort

Document   61 — CMS-1500: Poole, Carla

Document   62 — Eligibility Information Sheet (Cupp, Phillip D.)

Document   63 — CMS-1500: Attricks, Sherry

Document   64 — CMS-1500: Dunnitt, Candy

Document   65 — CMS-1500: Attricks, Petey

Document   66 — CMS-1500: Pendent, Andy

Document   67 — CMS-1500: Pendent, Codie

Document   68 — CMS-1500: Dunnitt, D. Jobb

Document   69 — CMS-1500: Pendent, Dee

Document   70 — CMS-1500: Dunnitt, D. Jobb

Document   71 — CMS-1500: Waite, Hugh

Document   72 — CMS-1500: O’Gen, Cass N.

Document   73 — Note: Incorrect Payment Worksheets

Document   74 — Payment Worksheet: Chance, Luke E.

Document   75 — Payment Worksheet: Chance, Luke E.

Document   76 — Coordination of Benefits: Chance, Luke E.

Document   77 — Medicare Remittance Notice

Document   78 — CMS-1500: Cupp, Phillip D.

Document   79 — CMS-1500: Hart, Shay Kee

Document   80 — CMS-1500: Hart, Brooke N.

Document   81 — CMS-1500: Hart, Brooke N.

Document   82 — CMS-1500: Waite, Hugh

Document   83 — CMS-1500: Knose, Ron E.

Document   84 — CMS-1500: O’Gen, Cass N.

Document   85 — CMS-1500: Allity, Rhea

Document   86 — CMS-1500: Waite, P. Lisa

Document   87 — Memo: Winter Insurance Company

Document   88 — Memo: Rover Insurers, Inc.

Document   89 — CMS-1500: Attricks, Petey

Document   90 — CMS-1500: Attricks, Sherry

Document   91 — CMS-1500: Allity, Rhea

Document   92 — CMS-1500: Waite, P. Lisa

Document   93 — CMS-1500: Akenja-Nearing, Jeanette

Document   94 — CMS-1500: O’Gen, Cass N.

Document   95 — CMS-1500: Fore-Theroad, Juana

Document   96 — CMS-1500: Theroad, Kent C.

Document   97 — CMS-1500: Theroad, Ian N.

Document   98 — CMS-1500: Theroad, Ian N.

Document   99 — CMS-1500: Fore-Theroad, Juana

Document 100 — CMS-1500: Theroad, Donette

Document 101 — CMS-1500: Pendent, Dee

Document 102 — CMS-1500: Poole, Wade N.

Document 103 — CMS-1500: Knose, Beane Andy

Document 104 — Letter from Mr. I Will Wright

Document 105 — CMS-1500: Theroad, Ian N.

Document 106 — CMS-1500: Theroad, Ian N.

Document 107 — CMS-1500: Waite, Hugh

Document 108 — CMS-1500: Fore-Theroad, Juana

Document 109 — CMS-1500: Fore-Theroad Juana

Document 110 — UB-92: Pendent, Codie

Document 111 — UB-92: Allity, Rhea

Document 112 — UB-92: Attricks, Sherry

Document 113 — UB-92: Akenja-Nearing, Jeanette

Document 114 — UB-92: Poole, Wade N.

Document 115 — UB-92: Poole, Gene

Document 116 — UB-92: Allity, Mort

Document 117 — CMS-1500: Dunnitt, D. I.

Document 118 — CMS-1500: Dunnitt, D. I.

Document 119 — CMS-1500: Fraide, Jose

Document 120 — CMS-1500: Poole, Carla

Document 121 — CMS-1500: Theroad, Ian N.

Document 122 — CMS-1500: Pendent, Codie

Document 123 — CMS-1500: Theroad, Ian N.

Document 124 — Dental Claim Form: Early, Brighton

Document 125 — Dental Claim Form: O’Gen, Cass N.

Document 126 — Dental Claim Form: Poole, Carla

Document 127 — Dental Claim Form: Waite, Ova

Document 128 — Dental Claim Form: Attricks, Sherry

Document 129 — Dental Claim Form: Poole, Gene

Document 130 — Dental Claim Form: Attricks, Petey

Document 131 — CMS-1500: Theroad, Ian N.

Document 132 — CMS-1500: Theroad, Ian N.

Document 133 — CMS-1500: Waite, Hugh

Document 134 — CMS-1500: Fore-Theroad, Juana

Document 135 — CMS-1500: Fore-Theroad, Juana

Document 136 — CMS-1500: Fore-Theroad, Juana

Document 137 — CMS-1500: Waite, P. Lisa

Document 138 — CMS-1500: Attricks, Petey

Document 139 — Medicare Remittance Notice

Document 140 — CMS-1500: Harps, Evan Lee

Document 141 — CMS-1500: Cupp, Phillip D.

Document 142 — CMS-1500: Fraide, Jose

Document 143 — CMS-1500: Attricks, Sherry

Document 144 — CMS-1500: O’Gen, Cass N.

Document 145 — CMS-1500: Theroad, Ian N.

Document 146 — CMS-1500: Akenja-Nearing, Jeanette

Document 147 — CMS-1500: Theraod, Ian N.

Document 148 — CMS-1500: Waite, Hugh

Document 149 — Dental Claim Form: Dunnitt, Candy

Document 150 — Dental Claim Form: Dunnit, D. I.

Document 151 — Dental Claim Form: Waite, Hugh

Document 152 — Dental Claim Form: Akenja-Nearing, Jeanette

Document 153 — Dental Claim Form: Poole, Carla

Document 154 — Dental Claim Form: Attricks, Petey

Document 155 — Dental Claim Form: Attricks, Sherry

Document 156 — Dental Claim Form: O’Gen, Cass N.

Document 157 — CMS-1500: Dunnitt, D. I.

Document 158 — CMS-1500: Waite, P. Lisa

Document 159 — CMS-1500: Theroad, Ian N.

Document 160 — CMS-1500: Poole, Carla

Document 161 — CMS-1500: Fore-Theroad, Juana

Document 162 — CMS-1500: Fore-Theroad, Juana

Document 163 — CMS-1500: O’Gen, Cass N.

Document 164 — CMS-1500: Fraide, Jose

Document 165 — CMS-1500: Fore-Theroad, Juana

Document 166 — CMS-1500: Theroad, Kent C.

Document 167 — CMS-1500: Theroad, Ian N.

Document 168 — CMS-1500: Theraod, Ian N.

Document 169 — CMS-1500: O’Gen, Pat N.

Document 170 — CMS-1500: Waite, Ova

Document 171 — CMS-1500: Attricks, Sherry

Document 172 — CMS-1500: Fever, Scarlet

Document 173 — CMS-1500: Fever, Scarlet

Document 174 — CMS-1500: Fraide, Jose

Document 175 — CMS-1500: Fraide, Jose

Document 176 — CMS-1500: Fraide, Jose

Document 177 — UB-92: Hart, Brooke N.

Document 178 — UB-92: Attricks, Petey

Document 179 — UB-92: Waite, P. Lisa

Document 180 — UB-92: O’Gen, Cass N.

Document 181 — UB-92: Fore-Theroad, Juana

Document 182 — UB-92: Theroad, Kent C.

Document 183 — UB-92: Theroad, Ian N.

Document 184 — UB-92: Waite, Hugh

Document 185 — UB-92: Fever, Scarlet

Document 186 — CMS-1500: Dunnitt, Candy

Document 187 — CMS-1500: Dunnitt, D. Jobb

Document 188 — CMS-1500: Poole, Wade N.

Document 189 — CMS-1500: Waite, P. Lisa

Document 190 — CMS-1500: Knose, Beane Andy

Document 191 — Medicare Remittance Notice

Document 192 — CMS-1500: Cupp, Hick

Document 193 — CMS-1500: Cupp, Phillip D.

Document 194 — CMS-1500: Hart, Shay Kee

Document 195 — CMS-1500: Cupp, Phillip D.

Document 196 — CMS-1500: Cupp, Phillip D.

Document 197 — CMS-1500: Dunnitt, Candy

Document 198 — CMS-1500: Dunnitt, D. Jobb

Document 199 — CMS-1500: Theroad, Kent C.

Document 200 — CMS-1500: Theroad, Donette

Document 201 — CMS-1500: Fore-Theroad, Juana

Document 202 — CMS-1500: Theraod, Ian N.

 

Section 4. Forms

 

Payment Worksheet

Inventory/Production Sheet

Authorization for Treatment Form

Payment Demand Letter

TPL Possible Further Information Request

Right of Reimbursement Claims Form

TPL Investigation Questionnaire

Third Party Liability Reimbursement Agreement

Preexisting Condition Form

Telephone Information Sheet

Claim Office Referral Sheet

Coordination of Benefits Calculation Worksheet

Request for Additional Information Form

 

Pearson Higher Education offers special pricing when you choose to package your text with other student resources. If you're interested in creating a cost-saving package for your students, contact your Pearson Higher Education representative for pricing and ordering information.

Pearson Higher Education offers special pricing when you choose to package your text with other student resources. If you're interested in creating a cost-saving package for your students, browse our available packages below, or contact your Pearson Higher Education representative to create your own package.



Copyright ©2008 Pearson Education. All rights reserved. Legal Notice | Privacy Policy | Permissions