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Reimbursement-chap3

chapter three terms

QuestionAnswer
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
Created by: 750264012