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Reimbursement-chap3
chapter three terms
Question | Answer |
---|---|
Actual Charge | amount provider actually bills a patient, which may differ from the allowable charge |
Adjudication | the determination of the reimbursement payment based on the member's insurance benefits |
Adverse Selection | enrollment of excessive proportion of persons with poor health status in a healthcare plan or healthcare organization |
Allowable Charge | average or maximum amount the third-party payer will reimburse providers for the service |
Appeal | request for consideration of denial of coverage or rejection of claim |