Claim Processing Terms Crossword Puzzle

QUESTIONS LIST:

• unprocessed : claim that has been received but has not yet been assigned a claim classification
• deficient denied : claim denied for the purpose of obtaining additional information from the provider
• adjudicated denied : a clean claim that has been denied for payment
• adjusted : claim that has been previously adjudicated as a clean claim and has had a subsequent payment update
• deficient : claim submitted that does not contain the data necessary to adjudicate and process the claim.
• adjudicated paid : clean claim for which a payment has been made to the provider
• duplicate : claim submitted by the provider that was included in a previously submitted claim by that provider for the same service provided to the same member
• deficient pended : claim pended for the purpose of obtaining additional information from the provider
• appealed : claim that has been previously adjudicated as a clean claim and the provider sends written notification that they disagree
• capita ted : claim submitted by a provider for rendered services for which the provider has been prepaid
• rejected : claim cmchp can not process for various reasons