Glossary
Claim
Your medical bill that is sent to an insurance company for payment.
What is the abbreviation for health maintenance organization?
HMO
What is a prefix?
Beginning part of a medical term
Missing or invalid claims information
A denial can be triggered when a claim form is incomplete. Missing or wrong data on a claim could be everything from social security numbers to plan codes, modifiers, addresses, and other demographic and technical errors.
00100 - 01999; 99100 - 99140
Anesthesia
Consent for treatment
An agreement you sign that gives you permission to receive medical services or treatment from doctors or hospitals.
What is another name for T19?
Medicaid
What is a suffix?
The ending of a medical term.
Duplicate claim or service
This type of denial occurs when claims are resubmitted for a single encounter on the same date by the same health care provider for the same beneficiary for the same service
0002M - 0013M, 0001U - 0171U, 80047 - 89398
Pathology and Laboratory
Discharge hour
The time a patient is discharged from the hospital.
What is the age in which one becomes eligible for Medicare unless disabled?
65
What does the prefix pre- mean?
To come before.
Service already adjudicated
This type of denial occurs when a service is already included in another claim/payment which was already settled.
90281 - 99199, 99500 - 99607
FREE! FREE! FREE!
Drugs/self-administered
Drugs that do not require administration from doctors or nurses. Your insurance plan may not cover these when provided as part of an outpatient service.
What is the term used for an individual that pays the premiums for an insurance policy?
Policyholder
This suffix means disease.
pathy
COB Denial
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20000-29999
Surgical Procedures
Durable medical equipment (DME)
The medical equipment that can be used many times, or special equipment ordered by your doctor, usually for use at home.
What is SCHIP?
State insurance that covers children
This group created and updates the insurance claim forms.
NUCC (national uniform claim committee).
MINUS 500
CPT 58120
MINUS 500