Claim Submission
Claim Rejection
A claim or transaction could not enter or continue processing because of an error or unmet front-end requirement. A common beginner confusion: A rejection is different from a claim that was adjudicated and denied.
Rendering Provider
The individual provider who performed or rendered the reported service in the relevant billing context. A common beginner confusion: Rendering and billing provider are not always the same.
Billing Provider
The provider or organization submitting the claim and receiving billing correspondence or payment in the applicable context. A common beginner confusion: Billing provider is not automatically the person who performed the service.
Provider
A healthcare professional or organization that furnishes or supports healthcare services. A common beginner confusion: The word provider does not always mean the same person or organization in every field.
CPT
A code set commonly used to report medical procedures and professional services in appropriate billing contexts. A common beginner confusion: Recognizing CPT is not the same as being trained or authorized to code.
ICD-10-CM
A diagnosis classification system used in US healthcare reporting and billing contexts. A common beginner confusion: A diagnosis code is not something an unqualified VA should infer from symptoms.
HCPCS
A coding system used for certain products, supplies, services, and procedures in applicable billing contexts. A common beginner confusion: HCPCS and CPT overlap in some contexts but are not the same code set.
CMS-1500
A standard claim form used for certain professional healthcare claims. A common beginner confusion: Learning the form layout is not coding or billing certification.
Claim Rejection vs Claim Denial
Identify where a rejection and denial occur and read the actual response before choosing a next step. This beginner module connects the concept to Claim Submission, Denial / Rejection Review, Correction / Appeal and includes a fictional practice activity.
Claim Submission Overview
A high-level, non-coding-authority overview of preparing and sending a claim through approved billing systems. It usually involves Medical billers and authorized claims support staff. and appears during Coding Review, Claim Submission.