Vocabulary
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Appeal | A request for a review of an insurance claim that has been underpaid or denied by and insurance company to receive additional payment.
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| Denied Claim | An insurance claim submitted to an insurance company in which payment has been rejected.
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| EOB | Explanation of Benefits:A document detailing services billed and describing payment determinations.
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| RA | Remittance Advice: A document detailing services billed and describing payment determination issued to providers of the medicare or medicaid program
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| Tracer | An inquiry made to an insurance company to locate the status of an insurance claim.
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| Inquiry | See Tracer
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| NPI | National Provider Identifier: A lifetime 10-digit number issued to providers.
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| Delinquent Claim | An insurance claim submitted to an insurance company, for which payment is overdue.
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| Overpayment | Money paid over and above the amount due by the insurer or patient.
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| 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.
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| 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.
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| 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.
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| HIPAA | Health Insurance Portability and Accountability Act: Guidelines and regulations to ensure the privacy of patients.
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| ERISA | Employee Retirement Income Security Act:Governs health insurance that is provided as a benefit of employment.
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| FTC | Federal Trade Commission:Board that regulates interstate trade and fraudulent price fixing.
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Created by:
RacheleCarter
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