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Ch 9 - Vocabulary
Vocabulary
Term | Definition |
---|---|
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. |