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Stack #598708

Terminology Mod 150, Unit 1

ALJ administrative law judge
Appeal A request for review of an insurance claim that has been underpaid or denied by an insurance company to receive additional payment
CMS Center for Medicare and Medicaid Services
DAB Departmental Appeal Board
Delinquent claim an insurance claim submitted to an insurance company, for which payment is overdue
Denied paper or electronic claim an insurance claim submitted to an insurance company which payment has been rejected owing to a technical error or because of medical coverage policy issues
ERISA Employee Retirement Income Security Act
Explanation of Benefits (EOB) A document detailing services billed and describing payment determinations; also known in Medicare, Medicaid, and some other programs as a remittance advice
FTC Federal Trade Commission
HCPCS Healthcare Common Procedure Coding System
HIPAA Health Insurance Portability and Accountability
HMO health maintenance organization
HO hearing officer
Inquiry Tracer; an inquiry made to an insurance company to locate the status of an insurance claim
Lost claim an insurance claim that cannot be located after sending it to insurer
Medigap(MG) A specialized supplemental insurance policy devised for Medicare beneficiary that covers the deductible and copayment amounts typically not covered under the main Medicare policy written by a nongovernmental third-party payer
NPI National Provider Identifier
Overpayment Money paid over and above the amount due by the insurer or patient
Peer review the review of a patients case by one and more physicians using federal guidelines to evaluate another physician in regard to the quality and efficiency of medical care
Rebill (resubmit) to send another request for payment for an overdue bill to either the insurance company or patient
Rejected claim an insurance carrier that is discarded by the system because of a technical error or because it does not follow Medicare instructions
Remittance advice (RA) A document detailing services billed and describing payment determination issued to providers of the Medicare or Medicaid program
Review to look over a claim to access how much payment should be made
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
Tickler file an alternative manual method used to track pending or resubmitted insurance claims
TRICARE A three-option managed health care program offered to spouses and dependents of service personal with uniform benefits and fees implemented nationwide by the federal government
UPIN Unique Provider Identification Number
Aging reports each month a report should be run that will indicate which claims are outstanding
Ambi- both, both sides, around, about
Bi- two, double
Circum- around
Deca- ten
Infer- below
Inter- between
Intra- within
Nulli- none
Poly- many, much, excessive
Super- upper, above
-algesia condition of pain
-blast immature cell, germ cell
-cyst bladder, sac
-graphy recording
-lepsy seizure
-lysis destruction, separation -ectomy
-genesis formation, produce
-orexia appetite
-rrhage to burst forth bursting forth
-rrhaphy suture
-rrhexis rupture