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  2. Health Insurance Portability and Accountability Act - Wikipedia

    en.wikipedia.org/wiki/Health_Insurance...

    EDI Retail Pharmacy Claim Transaction (NCPDP Telecommunications is used to submit retail pharmacy claims to payers by health care professionals who dispense medications, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit claims for retail pharmacy services and billing payment information ...

  3. Medical billing - Wikipedia

    en.wikipedia.org/wiki/Medical_billing

    Claims that are denied or underpaid may require follow-up, appeals, or adjustments by the medical billing department. [ 5 ] Accurate medical billing demands proficiency in coding and billing standards, a thorough understanding of insurance policies, and attention to detail to ensure timely and accurate reimbursement.

  4. National Provider Identifier - Wikipedia

    en.wikipedia.org/wiki/National_Provider_Identifier

    A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...

  5. The Business Associate Agreement: A Legally Required Contract

    www.aol.com/news/business-associate-agreement...

    A “covered entity” is defined at 45 C.F.R. Section 160.103 as a health plan, a health care clearinghouse or “a health care provider who transmits any health information in electronic form in ...

  6. 'Deny, deny, deny': By rejecting claims, Medicare Advantage ...

    www.aol.com/news/deny-deny-deny-repeatedly...

    A report last year by the department’s Inspector General found that in June 2019, the 15 top Medicare Advantage plans denied authorization for 13 percent of claims that had met Medicare rules ...

  7. Centers for Medicare & Medicaid Services - Wikipedia

    en.wikipedia.org/wiki/Centers_for_Medicare...

    HCFA was renamed the Centers for Medicare and Medicaid Services on July 1, 2001. [9] [11] In 2013, a report by the inspector general found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011. [12] In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most. [13]

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