Terminology Mod 150, Unit 1
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| ALJ | administrative law judge
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| Appeal | A request for review of an insurance claim that has been underpaid or denied by an insurance company to receive additional payment
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| CMS | Center for Medicare and Medicaid Services
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| DAB | Departmental Appeal Board
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| Delinquent claim | an insurance claim submitted to an insurance company, for which payment is overdue
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| 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
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| ERISA | Employee Retirement Income Security Act
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| 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
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| FTC | Federal Trade Commission
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| HCPCS | Healthcare Common Procedure Coding System
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| HIPAA | Health Insurance Portability and Accountability
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| HMO | health maintenance organization
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| HO | hearing officer
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| Inquiry | Tracer; an inquiry made to an insurance company to locate the status of an insurance claim
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| Lost claim | an insurance claim that cannot be located after sending it to insurer
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| 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
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| NPI | National Provider Identifier
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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 patients case by one and more physicians using federal guidelines to evaluate another physician in regard to the quality and efficiency of medical care
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| Rebill (resubmit) | to send another request for payment for an overdue bill to either the insurance company or patient
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| Rejected claim | 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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| Remittance advice (RA) | A document detailing services billed and describing payment determination issued to providers of the Medicare or Medicaid program
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| Review | to look over a claim to access how much payment should be made
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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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| Tickler file | an alternative manual method used to track pending or resubmitted insurance claims
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| 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
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| UPIN | Unique Provider Identification Number
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| Aging reports | each month a report should be run that will indicate which claims are outstanding
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| Ambi- | both, both sides, around, about
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| Bi- | two, double
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| Circum- | around
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| Deca- | ten
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| Infer- | below
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| Inter- | between
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| Intra- | within
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| Nulli- | none
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| Poly- | many, much, excessive
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| Super- | upper, above
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| -algesia | condition of pain
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| -blast | immature cell, germ cell
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| -cyst | bladder, sac
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| -graphy | recording
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| -lepsy | seizure
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| -lysis | destruction, separation -ectomy
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| -genesis | formation, produce
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| -orexia | appetite
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| -rrhage | to burst forth bursting forth
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| -rrhaphy | suture
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| -rrhexis | rupture
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