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NHA CBCS Chapter 2 - Claims Processing questions and answers already graded A+ 2025/2026
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NHA CBCS Chapter 2 - Claims Processing questions and answers already graded A+ 2025/2026
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NHA CBCS Chapter 2 - ClaimsProcessing
1. Adjustment Categories - ANS-- Denied Claim
2. - Zero Payment
3. - Partial Payment
4. - Additional Payment
5. - Reduced Payment
6. - Supplemental Payment
7. Allowable Charge - ANS-The amount an insurer will accept as full price, minus relevant
value sharing.
8. ASCA 2012 - ANS-Administration Simplification Compliance Act, part of HIPAA,
mandates that healthcare claims be submitted electronically.
9. Assignment of Benefits - ANS-Contract wherein the issuer at once bills the payer and
accepts the allowable fee.
10. Claim - ANS-A entire record of the offerings provided by means of the healthcare expert,
at the side of suitable insurance information.
11. Clean Claim - ANS-Accurate and whole. They have all the records wanted for
processing, that's achieved in a well timed fashion.
12. Clearinghouse - ANS-Agency that converts claims into a standardized digital layout,
seems for mistakes, and formats them consistent with HIPAA and insurance
requirements.
13. CMS-1450/UB-04 (837-I) - ANS-Standard claim form to invoice Medicare administrative
contractors (MACs) while a paper declare is permitted.
14. CMS-1500 - ANS-Specific form that companies have to fill out to bill Medicare required
through ASCA.
15. - Revised through NUCC
16. - New bureaucracy should be authorised by the White House Office of Management &
Budget (OMB)
17. Conditional Payment - ANS-Medicare fee this is recovered after number one coverage
pays.
18. Coordination of Benefits - ANS-Determines which insurance plan is primary in which is
secondary.
19. Crossover Claims - ANS-Claim submitted with the aid of humans blanketed via a primary
and secondary coverage plan, which include Medicare and Medicaid. Medicare obtained
the bill first, applies a deductible/coinsurance and then robotically forwards it to
Medicaid. Companies no longer ought to invoice Medicaid one after the other for the
Medicare deductible, coinsurance, or co-pay quantity.
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