HIM 2133 Module 3 Assignment Prepare Insurance Claims for Submission

HIM 2133 Module 3 Assignment Prepare Insurance Claims for Submission

Prepare Insurance Claims for Submission

This assignment will provide you with insight into the use of data as it flows throughout the revenue cycle. Information gathered at the time of registration (demographics, insurance information, and admission date), charge capture throughout treatment and provision of services, the application of ICD-10, CPT, and HCPCs codes as well as provider information culminates in the claim form that is finalized and submitted for payment.

In this assignment, you will prepare two CMS-1500 and two UB-04 insurance claim forms using the data in four case scenarios.

To complete this assignment, do the following:

Download the zip file containing the four case scenarios below.

Case Scenarios

Download the CMS-1500 and UB-04 forms below.

CMS-1500 Form

UB-04 Form

Save two copies of each form on your computer (one for each of the two CMS-1500 scenarios and one for each of the two UB-04 scenarios). Save each form with a unique file name. Include the Case ID and form type in the file name (for example, CMS15001a, CMS15001b, UB2a, UB2b).

Download the instructions for completing the CMS-1500 and UB-04 forms below.

Instructions for Completing the CMS-1500 and UB-04 Forms

Using Adobe Acrobat Reader, enter the information from the case scenario into the appropriate field on the corresponding form. Refer to your readings for Physician and Hospital Medical Billing for information on CMS-1500 and UB-04 form locators and required information.

(If you do not have Adobe Acrobat Reader, download it from the Adobe website.)

For the CMS-1500 forms: Enter your name and date in the box in the upper left of the form. Enter the Case ID in the box in the upper right. Complete all pertinent fields #1-11d and 14-33 according to the data in the case and the guidelines you downloaded in Step 4.

For the UB-04 forms: Enter your name, the date, and the Case ID in the “Responsible Party” field (field 38) on the form. Complete all pertinent fields according to the data in the case and the guidelines you downloaded in Step 4.

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Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.

Also Check Out: HIM 2133 Module 2 Assignment   Data Reporting Analysis

Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.

One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.

I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.

In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).

Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).

Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.

I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.

As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.

It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.


Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.