21 matching questions.
A deductible is the amount a patient may need to pay before the insurance plan begins sharing certain covered costs. A copayment is usually a fixed amount for a covered service, w…
A rejection usually means the claim was not accepted for adjudication because of a format, data, or submission issue, while a denial means the payer accepted and processed the cla…
A clean claim is a complete and accurate claim that can be processed without needing additional information or correction. A rejected claim is not accepted for adjudication becaus…
CAQH Provider Data Portal is a centralized platform many healthcare organizations and health plans use to collect provider professional and practice information. Providers maintai…
An NPI is a 10-digit National Provider Identifier used to identify healthcare providers in HIPAA standard transactions. A Type 1 NPI identifies an individual healthcare provider,…
Payer enrollment is the process of establishing a provider or organization in a payer’s billing system so claims and payments can be processed correctly. After credentialing, cont…
Timely filing is the payer's deadline for submitting an initial claim or, in some cases, corrected claims and appeals within a defined period.
A duplicate claim denial occurs when the payer believes the same or substantially similar service has already been submitted or processed.
An eligibility denial occurs when the payer determines that the patient was not covered, not active, or not eligible for the billed service on the date of service.
PECOS is CMS’s online Medicare enrollment management system. Providers and suppliers can use it to submit enrollment applications, update enrollment information, upload supporting…