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Ch 9 - Vocabulary


Appeal A request for a review of an insurance claim that has been underpaid or denied by and insurance company to receive additional payment.
Denied Claim An insurance claim submitted to an insurance company in which payment has been rejected.
EOB Explanation of Benefits:A document detailing services billed and describing payment determinations.
RA Remittance Advice: A document detailing services billed and describing payment determination issued to providers of the medicare or medicaid program
Tracer An inquiry made to an insurance company to locate the status of an insurance claim.
Inquiry See Tracer
NPI National Provider Identifier: A lifetime 10-digit number issued to providers.
Delinquent Claim An insurance claim submitted to an insurance company, for which payment is overdue.
Overpayment Money paid over and above the amount due by the insurer or patient.
Peer Review The review of a patient's case by one or more physicians using federal guidelines to evaluate another physician in regard to the quality and efficiency of medical care.
Suspended Claim An insurance claim that is processed by the insurance carrier but held in an indeterminate (pending) state about payment either because of an error or the need for additional information.
Rejected Claim An insurance claim submitted to an insurance carrier that is discarded by the system because of a technical error or because it does not follow Medicare instructions.
HIPAA Health Insurance Portability and Accountability Act: Guidelines and regulations to ensure the privacy of patients.
ERISA Employee Retirement Income Security Act:Governs health insurance that is provided as a benefit of employment.
FTC Federal Trade Commission:Board that regulates interstate trade and fraudulent price fixing.
Created by: RacheleCarter