PROCESSING AN INSURANCE CLAIM-HEALTH INS BOOK
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| show | PROVIDER ACCEPTS AS PAYMENT IN FULL WHATEVER IS PAID ON THE CLAIM BY THE PAYER(EXCEPT FOR ANY COPAYMENT AND/OR COINSURANCE AMOUNTS)
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| show | AMOUNT OWED TO A BUSINESS FOR SERVICES OR GOODS PROVIDED
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| show | SHOWS THE STATUS (BY DATE) OF OUTSTANDING CLAIMS FROM EACH PAYER, AS WELL AS PAYMENTS DUE FROM PATIENTS
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| ACCOUNTS RECEIVABLE MANAGEMENT | show 🗑
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| ALLOWED CHARGE | show 🗑
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| show | USE A VARIABLE-LENGTH FILE FORMAT TO PROCESS TRANSACTIONS FOR INSTITUTIONAL, PROFESSIONAL, DENTAL, AND DRUG CLAIMS
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| APPEAL | show 🗑
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| show | THE PROVIDER RECEIVES REIMBURSEMENT DIRECTLY FROM THE PAYER
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| BAD DEBT | show 🗑
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| BENEFICIARY | show 🗑
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| BIRTHDAY RULE | show 🗑
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| show | TERM HOSPITALS USE TO DESCRIBE A PATIENT ENCOUNTER FORM
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| show | COMPARING A CLAIM TO PAYER EDITS AND THE PATIENT'S HEALTH PLAN BENEFITS TO VERIFY THAT THE REQUIRED INFORMATION IS AVAILABLE TO PROCESS THE CLAIM; THE CLAIM IS NOT A DUPLICATE
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| show | MEDICAL REPORT SUBSTANTIATING A MEDICAL CONDITION
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| CLAIMS PROCESSING | show 🗑
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| CLAIMS SUBMISSION | show 🗑
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| CLEAN CLAIM | show 🗑
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| show | PERFORMS CENTRALIZED CLAIMS PROCESSING FOR PROVIDERS AND HEALTH PLANS
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| CLOSED CLAIM | show 🗑
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| show | PERCENTAGE THE PATIENT PAYS FOR COVERED SERVICES AFTER THE DEDUCTIBLE HAS BEEN MET AND THE COPAYMENT HAS BEEN PAID
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| COMMON DATA FILE | show 🗑
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| show | CONSIDERED LANDMARK LEGISLATION BECAUSE IT LAUNCHED TRUTH-IN-LENDING DISCLOSURES THAT REQ'D CREDITORS TO COMMUNICATE THE COST OF BORROWING MONEY IN A COMMON LANGUAGE SO THAT CONSUMERS COULD FIGURE OUT THE CARGES, COMPARE COSTS,SHOP FOR BEST CREDIT DEAL
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| show | PROVISION IN GROUP HEALTH INSURANCE POLICIES THAT PREVENTS MULTIPLE INSURERS FROM PAYING BENEFITS COVERED BY OTHER POLICIES;ALSO SPECIFIES THE COVERAGE WILL BE PROVIDED IN A SPECIFIC SEQUENCE WHEN MORE THAN ONE POLICY COVERS THE CLAIM
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| COVERED ENTITY | show 🗑
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| show | "MANUAL DAILY ACCOUNTS RECEIVABLE JOURNAL" CHRONOLOGICAL SUMMARY OF ALL TRANSACTIONS POSTED TO INDIVIDUAL PATIENT LEDGERS/ACCOUNTS ON A SPECIFIC DAY
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| show | ONE THAT HAS NOT BEEN PAID WITHIN A CERTAIN TIME FRAME (E.G., 120 DAYS)
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| DELINQUENT CLAIM | show 🗑
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| DELINQUENT CLAIM CYCLE | show 🗑
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| show | ASSIGNING LOWER-LEVEL CODES THAN DOCUMENTED IN THE RECORD
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| ELECTRONIC CLAIMS PROCESSING | show 🗑
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| ELECTRONIC DATA INTERCHANGE (EDI) | show 🗑
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| ELECTRONIC FLAT FILE FORMAT | show 🗑
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| ELECTRONIC FUNDS TRANSFER (EFT) | show 🗑
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| show | ESTABLISHED THE RIGHTS, LIABILITIES, AND RESPONSIBILITIES OF PARTICIPANTS IN ELECTRONIC FUNDS TRANSFER SYSTEMS
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| ELECTRONIC HEALTHCARE NETWORK ACCREDITATION COMMISSION (EHNAC) | show 🗑
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| show | ELECTRONIC FLAT FILE FORMAT
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| show | REMITTANCE ADVICE THAT IS SUBMITTED TO THE PROVIDER ELECTRONICALLY AND CONTAINS THE SAME INFO. AS A PAPER-BASED REMITTANCE ADVICE; PROVIDERS RECEIVE THEM MORE QUICKLY
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| ENCOUNTER FORM | show 🗑
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| EQUAL CREDIT OPPORTUNITY ACT | show 🗑
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| show | AMENDED THE TRUTH IN LENDING ACT, REQUIRING CREDIT & CHARGE CARD ISSUERS TO PROVIDE CERTAIN DISCLOSURES IN DIRECT MAIL, TELEPHONE, & OTHER APPLICATIONS & SOLICITATIONS FOR OPEN-END CREDIT &CHARGE ACCOUNTS;LAW APPLIES TO PROVIDERS THAT ACCEPT CREDIT CARDS
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| show | FEDERAL LAW PASSED 1975 THAT HELPS CONSUMERS RESOLVE BILLING ISSUES WITH CARD ISSUERS; PROTECTS IMPORTANT CREDIT RIGHTS, INCLUDING RIGHTS TO DISPUTE BILLING ERRORS, UNAUTHORIZED USE OF AN ACCOUNT, AND CHARGES FOR UNSATISFACTORY GOODS AND SERVICES
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| FAIR CREDIT REPORTING ACT | show 🗑
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| FAIR DEBT COLLECTION PRACTICES ACT (FDCPA) | show 🗑
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| GUARANTOR | show 🗑
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| LITIGATION | show 🗑
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| MANUAL DAILY ACCOUNTS RECEIVABLE JOURNAL/DAY SHEET | show 🗑
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| show | ANY PROCEDURE OR SERVICE REPORTED ON A CLAIM THAT IS NOT INCLUDED ON THE PAYER'S MASTER BENEFIT LIST, RESULTING IN DENIAL OF THE THE CLAIM;
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| NONPARTICIPATING PROVIDER (NONPAR) | show 🗑
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| OPEN CLAIM | show 🗑
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| show | ESTABLISHED BY HEALTH INSURANCE COMPANIES FOR A HEALTH INSURANCE PLAN; USUALLY HAS LIMITS OF $1,000 TO $2,000;WHEN THE PATIENT HAS RECEACHED THE LIMIT OF PAYMENT(E.G., ANNUAL DEDUCTIBLE)FOR THE YEAR, APPROPRIATE PATIENT REIMBURSEMENT IS DETERMINED
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| OUTSOURCE | show 🗑
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| PARTICIPATING PROVIDER (PAR) | show 🗑
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| PAST-DUE ACCOUNT - DELINQUENT ACCOUNT | show 🗑
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| show | A COMPUTERIZED PERMANENT RECORD OF ALL FINANCIAL TRANSACTIONS BETWEEN THE PATIENT AND THE PRACTICE
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| show | ANY MEDICAL CONDITION THAT WAS DIAGNOSED AND/OR TREATED WITHIN A SPECIFIED PERIOD OF TIME IMMEDIATELY PRECEDING THE ENROLLEE'S EFFECTIVE DATE OF COVERAGE
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| PRIMARY INSURANCE | show 🗑
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| show | REMITTANCE ADVICE SUBMITTED BY MEDICARE TO PROVIDERS THAT INCLUDES PAYMENT INFORMATION ABOUT A CLAIM
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| show | THE ROUTING SLIP, CHARGE SLIP, ENCOUNTER FORM, OR SUPERBILL FROM WHICH THE INSURANCE CLAIM WAS GENERATED
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| show | TERM USED FOR AN ENCOUNTER FORM IN THE PHYSICIAN'S OFFICE
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| show | PENDING
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| TWO-PARTY CHECK | show 🗑
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| UNASSIGNED CLAIM | show 🗑
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| UNAUTHORIZED SERVICE | show 🗑
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| UNBUNDLING | show 🗑
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| show | CLEARINGHOUSE THAT INVOLVES VALUE-ADDED VENDORS, SUCH AS BANKS, IN THE PROCESSING OF CLAIMS; USING A VAN IS MORE EFFICIENT AND LESS EXPENSIVE FOR PROVIDERS THAN MANAGING THEIR OWN SYSTEMS TO SEND AND RECEIVE TRANSACTIONS DIRECTLY FROM NUMEROUS ENTITIES
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To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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Created by:
Tina Everett