MOP 110 Ms. Ragadio
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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| accept assignment | : provider accepts as payment in full whatever is paid on the claim by the payer.
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| allowed charges | the maximum amount the payer will reimburse for each procedure or service, according to the patient's policy.
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| assignment of benefits | the provider receives reimbursement directly from the payer.
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| beneficiary | the person eligible to receive health care benefits.
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| birthday rule | determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
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| charge master | document that contains a computer generated list of procedures, services, and supplies with charges for each.
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| adjudication | judicial dispute resolution process in which an appeals board makes a final determination.
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| appeal | documented as a letter, signed by the provider, explaining why a claim should be reconsidered for payment.
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| clean claim | a correctly completed standardized claim.
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| clearinghouse | performs centralized claims processing for providers and health plans.
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| downcoding | assigning lower-level codes than documented in the record.
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| guarantor | person responsible for paying health care fees.
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