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The maximum amount an insurance plan will pay for a covered healthcare service.
Allowed Amount
A fixed amount you pay for a covered healthcare service, usually at the time you receive the service.
Copayment (Copay)
A statement sent by your insurance plan after they process a claim. It details the amount billed, the allowed amount, the amount paid, and the amount you owe. This is not a bill.
Explanation of Benefits (EOB)
Refers to providers or facilities that have not signed a contract with your health insurance plan.
Out-of-Network
An individual enrolled in a healthcare plan who is eligible for benefits.
Beneficiary
A standardized coding system used to describe medical, surgical, and diagnostic procedures and services.
CPT Codes (Current Procedural Terminology)
The patient's billing account number, used for reference when contacting the facility with questions.
Guarantor ID
The portion of the bill that the patient is required to pay, including deductibles, copayments, and coinsurance.
Patient Responsibility
A formal request for payment submitted by a healthcare provider (or patient) to an insurance company for services rendered.
Claim
What does CPT stand for?
(Current Procedural Terminology)
The International Classification of Diseases, 10th Edition, which is the coding system used to classify and code all diagnoses, symptoms, and procedures.
ICD-10
The health insurance company or entity responsible for paying claims (e.g., Medicare, Medicaid, Aetna, Cigna)
Payer
A federal law that may allow you to temporarily continue health coverage after your employment ends.
COBRA Insurance
The amount you owe for covered healthcare services before your health insurance plan begins to pay.
Deductible
A unique 10-digit identification number issued to healthcare providers in the United States.
NPI
An approval from your health insurance plan that it will cover a specific service or medication.
Pre-authorization/Precertification Pre-authorization/Precertification
The percentage of the costs of a covered medical service you are responsible for paying after you've paid your deductible (e.g., 20%).
Coinsurance
Equipment and supplies ordered by a healthcare provider for everyday or extended use, such as wheelchairs or oxygen equipment.
Durable Medical Equipment (DME)
What does NPI stand for?
National Provider Identifier
A four-digit code used in medical billing to specify the type of room, service, or billing a patient received.
Revenue Code