CHAA Denial Management and Claims Processing Flashcards
6 cards from real CHAA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CHAA Denial Management and Claims Processing flashcards as text
What is a claim denial in the context of healthcare revenue cycle?
Answer: When a payer refuses to reimburse a submitted claim fully or partially
A claim denial occurs when a payer determines that all or part of a submitted claim does not meet requirements for reimbursement, requiring follow-up or appeal.
Which type of denial can be corrected and resubmitted by the provider?
Answer: Soft denial (or correctable denial)
A soft denial is one where the payer will reconsider and pay the claim if additional information, a correction, or documentation is submitted.
What is a 'hard denial' in claims management?
Answer: A denial that is final and cannot be overturned without a formal appeal
A hard denial represents a final refusal to pay that requires a formal appeal process if the provider believes the denial is incorrect.
Which denial root cause originates in the patient access department due to missing or incorrect information at registration?
Answer: Front-end denial
Front-end denials are caused by errors or omissions in registration data such as incorrect demographics, missing insurance information, or absent authorizations.
What does 'timely filing' mean in the context of claim submission?
Answer: Submitting claims to the payer within the contractually specified deadline after service
Timely filing limits require claims to be submitted within a specified window (e.g., 90 or 180 days) after the date of service; claims submitted late are typically denied.
A claim is denied due to 'duplicate billing.' What does this mean?
Answer: The patient was billed twice for the same service within the same billing cycle
Duplicate billing occurs when the same service is submitted to a payer more than once, resulting in a denial on the second submission.