Which Involves Linking Every Procedure or Service Code Reported on the Claim

question 25

Multiple Choice

Which involves linking every procedure or service code reported on the claim to a condition code that justifies the necessity of performing that procedure or service?

• A) claims adjudication
• B) diagnosis coding
• C) medical necessity
• D) reimbursement processing

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Definitions:

Warranty Repairs

Services provided to repair or fix products covered under a warranty at no charge to the customer, typically within a specified time period after purchase.

Estimated Premium Claims

The projected claims that an insurance company expects to pay out based on the premiums it has received.

Coupons Redeemed

The act of exchanging a coupon for a discount, product, or service, usually part of a promotional offering.

Premium Expense

The cost associated with purchasing an insurance policy or the amount over the face value paid for a bond or stock.