|
Adjudication -
The final determination of the issues involving settlement of an insurance claim.
|
|
Adjustment -
The portion of medical bill that doctor or hospital has agreed not to charge Patient.
|
|
Aging -
Any claims or unpaid insurance that are due past 30 days.
|
|
AMA -
American Medical Association. The largest consortium of doctors in the US. Their publication: American Medical Association is a widely distributed medical journal in the world.
|
|
Ambulatory Care -
It includes all types of health services that do not require an overnight hospital stay.
|
|
Ancillary Service -
Services you need beyond room and board charges, such as laboratory tests, therapy, surgery and the like.
|
|
Appeal -
A process by which a doctor or the Patient can object to payer when they disagree with the health plan's decision not to pay for care provided.
|
|
AR -
(Accounts Receivables) It’s a term used to indicate outstanding amount of money that the hospital or physician are still hoping to get paid for.
|
|
Assignment of Benefits -
Insurance payments which are sent directly to the patient’s doctor or hospital
|
|
Authorization -
Approval of care required before a service is provided. Pre-authorization may be necessary before hospital admission, or before care is given by non-HMO providers.
|
|
Balance Bill -
The amount doctors charge patients have to pay after the patient's insurance and health plans have paid because the charges are above the Usual and Customary Rate or because the insurer considered a procedure medically unnecessary
|
|
Beneficiary -
Person or persons covered by the health insurance plan.
|
|
Bill/Invoice/Statemen -
Printed summary of patients’ medical bill.
|
|
Billing -
the procedure by which medical bills are collected from insurance companies within hospitals or other healthcare facilities.
|
|
Blue Cross and Blue Shield Association (BSBSA) -
An association which represents the common interests of Blue Cross and Blue Shield health plans. The BCBSA serves as the administrator for the Health Care Code Maintenance Committee and also helps maintain the HCPCS Level II codes.
|
|
Capitation -
A fixed payment paid per patient enrolled over a defined period of time, paid to a health plan or provider. This covers the costs associated with the patient’s health care services.
|
|
CAQH -
Council for Affordable Quality Healthcare. A non-profit union of healthcare related organization that governs the collaboration between insurance plans and healthcare providers.
|
|
CHAMPUS -
Civilian Health and Medical Program of the Uniformed Services. Now known as TRICARE. A federal health insurance for military personnel, National Guard, retirees, their families, and survivors.
|
|
Charity Care -
Medical care provided at no cost or at low cost to patients who cannot afford it.
|
|
Clean Claim -
A term used for a complete submitted insurance claim that has all the necessary correct information without any omissions or mistakes that allows it to be processed and paid promptly
|
|