In the cases that follow, you play the role of a medical
insurance specialist who is preparing HIPAA claims for
transmission. Assume that you are working with the practice’s PMP
to enter the transactions. The information you enter is based on
the patient information form and the encounter form. • Claim control
numbers are created by adding the eight-digit date to the patient
account number, as in AA026-10042029. • A copayment of $15
is collected from each Oxford PPO patient at the time of the visit.
A copayment of $10 is collected for Oxford HMO. For these case studies,
do subtract the copayment from the charges;
the payer’s allowed fees have already been reduced by the amount of
the copayment. Case 7.2 From the Patient Information Form A. What procedure code(s) is (are) being billed on the claim? B. List the name and the primary identification number of the
billing provider for this claim. C. Are the subscriber and the patient the same person? multiple choice Yes No D. What copayment is collected? E. What amount is being billed on the claim?
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