After reading Chapter Electronic Claims, you will complete an outline of the outcomes. Your outline should be organized and concise.

Outcomes:

1. Describe an electronic claim.
2. Define and discuss electronic data interchange.
3. Describe necessary components when adopting an accounts receivable management or computerized medical billing system.
4. Explain the difference between carrier-direct and clearinghouse electronically transmitted insurance claims.
5. Summarize the advantages of electronic claim submission.
6. Identify the transactions and code sets to use for insurance claims transmission.
7. Discuss the difference between insurance claim data elements which are required or situational for the 837P standard transaction format.
8. Define a claim attachment and discuss claim attachments standards.
9. Compare and contrast standard unique provider identifiers, health plan identifiers, and patient identifiers.
10. Name and discuss some methods of interactive computer transactions for transmitting insurance claims.
11. Discuss interactive transactions and relate the electronic funds transfer process and mandated requirements under the Affordable Care Act (ACA).
12. Define an electronic remittance advice and identify the ACS X12 Health Care Claim Payment/Advice (835).
13. Identify transmission reports generated to track the electronic claims process.
14. List computer transmission problems that can occur.