Question

1. Is the patient’s condition related to (employment/auto accident/other accident)
   1. Completely present on electronic claim
   2. Partially present or not clear on electronic claim
   3. Not present on electronic claim

2. Insured’s policy group or FECA number, date of birth, employer, plan name, benefit plan name (if applicable)
   1. Completely present on electronic claim
   2. Partially present or not clear on electronic claim
   3. Not present on electronic claim

3. Authorization release
   1. Completely present on electronic claim
   2. Partially present or not clear on electronic claim
   3. Not present on electronic claim

4. Insured’s signature
   1. Completely present on electronic claim
   2. Partially present or not clear on electronic claim
   3. Not present on electronic claim

5. Date of condition
   1. Completely present on electronic claim
   2. Partially present or not clear on electronic claim
   3. Not present on electronic claim

6. First date of condition
   1. Completely present on electronic claim
   2. Partially present or not clear on electronic claim
   3. Not present on electronic claim

7. Dates patient unable to work in current occupation
   1. Completely present on electronic claim
   2. Partially present or not clear on electronic claim
   3. Not present on electronic claim

8. Name of referring physician, I.D. number of referring physician
   1. Completely present on electronic claim
   2. Partially present or not clear on electronic claim
   3. Not present on electronic claim

9. Hospitalization dates related to current services
   1. Completely present on electronic claim
   2. Partially present or not clear on electronic claim
   3. Not present on electronic claim

10. N/A (Reserved for local use). Skip to next question.

11. Outside lab charges?
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

12. Diagnosis or nature of illness or injury
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

13. Medicaid resubmission code (if applicable)
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

14. Prior authorization number (if applicable)
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

15. Procedural codes for services rendered and related diagnostic code pointer
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

16. Federal tax I.D. number
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

17. Patient’s account number
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

18. Accept assignment? Yes or No
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

For 28-30, see the Ledger Tab. Keep in mind that you are auditing the availability of the fields themselves, and not the patient data, or lack thereof, entered in the fields.

19. Total charges
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

20. Amount paid
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

21. Balance due
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

22. Signature of physician to be reimbursed
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

23. Name and address of facility where the services were rendered
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

24. Physicians, suppliers billing name, address, zip code, and phone number
    1. Completely present on electronic claim
    2. Partially present or not clear on electronic claim
    3. Not present on electronic claim

25. List the items that were not completely present or were missing from the electronic claim.

26. Of the missing or incomplete items, which do you think would be most likely to cause this electronic claim to be rejected?

Answer 1

1.The correct optiona is :-

The patient’s condition related to (employment/auto accident/other accident)

- Partially present or not clear on electronic claimc.

2. The correct option is :-

Insured policy group or FECA number, date of birth, employer, plan name, benefit plan name (if applicable

- Not present on electronic claim

3. The correct option is :-

Authorization release

- Not present on electronic claim

4. The correct option is :-

Insured’s signature

- Not present on electronic claim

5. Date of condition

- Not present on electronic claim

6. First date of condition

- Not present on electronic claim

7. Dates patient unable to work in current occupation

- Not present on electronic claim

8. Name of referring physician, I.D. number of referring physician

- Not present on electronic claim

9. Hospitalization dates related to current services

-