Before your eClaims training you may want to familiarize yourself with some eClaim terminology. You will want to be familiar with the terms listed below. Please review the Glossary for a full list of terminology.
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Invalid v. Rejected v. Denied claims
The difference between invalid, rejected, and denied claims Claims sent electronically can be either rejected, denied or invalid. Invalid claims are stopped by MacPractice because of missing or incomplete claim information. MacPractice cannot filter for all billing criteria, but the software can catch some major issues before they get sent, enabling you to resolve issues quickly.
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The difference between credentialing and enrolling
Being credentialed refers to having Provider information on file with a Payer for the purpose of sending claims. The office is responsible for all Payer credentials. MacPractice cannot offer any assistance or advice with the credentialing process, however Medicare requires an 855 form to be completed to gain acceptance into the Medicare program. Visit CMS for more information on the credentialing process. Many payers use the terms credentialed and enrolled interchangeably, therefore MacPractice uses the term enrollment to refer exclusive to EDI enrollment.
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The difference between Individual NPI and Group NPI
Individual NPI also often referred to as Type 1 NPI is a unique identifier that is associated with a person that provides healthcare services and submits medical or dental claims. The Individual NPI is used for the purpose of identifying a rendering provider.
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