Terms : Hide Images
| 3627609655 | Primary Insurance | is the insurance plan responsible for paying health care insurance claims first. | 0 | |
| 3627612834 | Secondary Insurance | is the insurance plan that is billed after the primary insurance plan has paid its contracted amount (e.g., 80 percent of billed charges) and the provider's office has received a remittance advice from the primary payer. | 1 | |
| 3627649024 | Encounter Form | is the financial record source document used by health care providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter. | 2 | |
| 3627653402 | Claims Submission | is the electronic or manual transmission of claims data to payers or clearinghouses for processing. | 3 | |
| 3627660535 | Value-Added Network | is a clearinghouse that involves value-added vendors, such as banks, in the processing of claims. | 4 | |
| 3627672006 | Claims Attachment | is a set of supporting documentation or information associated with a health care claim or patient encounter. | 5 | |
| 3627675296 | Coordination of Benefits (COB) | is a provision in group health insurance policies intended to keep multiple insurers from paying benefits covered by other policies; it also specifies that coverage will be provided in a specific sequence when more than one policy covers the claim. | 6 | |
| 3627678388 | Claims Processing | involves sorting claims upon submission to collect and verify information about the patient and provider | 7 | |
| 3627723880 | Deductible | is the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the insurance company is obligated to pay any benefits. | 8 | |
| 3627725297 | Coinsurance | is the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid. | 9 | |
| 3627729601 | Open Claims | are organized by month and insurance company and have been submitted to the payer, but processing is not complete. | 10 | |
| 3627731069 | Closed Claims | are filed according to year and insurance company and include those for which all processing, including appeals, has been completed. | 11 | |
| 3627732475 | Unassigned Claims | are organized by year and are generated for providers who do not accept assignment; the file includes all unassigned claims for which the provider is not obligated to perform any follow-up work. | 12 | |
| 3627735073 | Pre-Existing Condition | is any medical condition that was diagnosed and/or treated within a specified period of time immediately preceding the enrollee's effective date of coverage. | 13 | |
| 3627737879 | Accounts Receivable | are the amounts owed to a business for services or goods provided.) | 14 | |
| 3627755768 | Medicare Drug Integrity Contractors (MEDIC) Program | implemented to assist with CMS audit, oversight, anti-fraud, and anti-abuse efforts related to the Medicare Part D benefit. | 15 | |
| 3627761123 | Medical Review (MR) | is defined by CMS as a review of claims to determine whether services provided are medically reasonable and necessary, as well as to follow up on the effectiveness of previous corrective actions. | 16 | |
| 3627763816 | Overpayments | are funds a provider or beneficiary receives in excess of amounts due and payable under Medicare and Medicaid statutes and regulations. | 17 | |
| 3627773169 | Confidentiality | involves restricting patient information access to those with proper authorization and maintaining the security of patient information. | 18 | |
| 3627775827 | Privacy | is the right of individuals to keep their information from being disclosed to others. | 19 | |
| 3627810168 | Record Retention | is the storage of documentation for an established period of time, usually mandated by federal and/or state law. | 20 | |
| 3627817667 | Participating Provider (PAR) | contracts with a health insurance plan and accepts whatever the plan pays for procedures or services performed. | 21 | |
| 3627830491 | Clearinghouse | is a public or private entity that processes or facilitates the processing of nonstandard data elements (e.g., paper claim) into standard data elements | 22 | |
| 3627851611 | Listserv | a subscriber-based question-and-answer forum available through e-mail. | 23 | |
| 3627926019 | Release of Information Log | is used to document patient information released to authorized requestors, and data are entered manually (e.g., three-ring binder) or using ROI tracking software. | 24 | |
| 3627939327 | Health Plan Identifier (HPID) | is assigned to third-party payers; it has 10 numeric positions, including a check digit as the tenth position. | 25 | |
| 3627953765 | Privileged Communication | Any information communicated by a patient to a health care provider | 26 | |
| 3627959922 | HIPAA Privacy Rule | creates national standards to protect individuals' medical records and other personal health information. | 27 | |
| 3627961981 | HIPAA Security Rule | adopts standards and safeguards to protect health information that is collected, maintained, used, or transmitted electronically | 28 | |
| 3627964662 | Release of information log | is used to document patient information released to authorized requestors, and data are entered manually (e.g., three-ring binder) or using ROI tracking software. | 29 |
