Terms 101
Current Procedural Terminology
What is CPT code?
System used to view electronic claims.
What is EDI?
Occurs when the healthcare provider does not have a contract with the Health Plan, and therefore does not accept the reduced allowed amount for a service as payment.
What is Balance Billing?
Modifier: 26
What is Professional Component?
IPA: 01
What is UPMC Health Plan Network?
Indicates that a service or procedure that has been performed has been altered.
What is a Modifier?
System used to view claims.
What is CCD?
Anesthesia is billed in ______ increments.
What is 15 minutes?
Modifier: RT
What is Right Side?
IPA: 09
What is Out of Network?
Used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters.
What is Diagnosis Code?
System used to determine coverage and cost share.
What is Cost Share Estimator?
A claim submitted within the timely filing guidelines where all required information is submitted and correct, and the claim is processed withing obtaining additional information from the provider of the service or from a third party.
What is a Clean Claim?
Modifier: LT
What is Left Side?
IPA: 13
What is Medical Mutual of Ohio (MMO)?
Used to determine coverage for certain services & medical equipment.
What are Medical Pay Policies?
System used to review pay policies.
What is MCN Policy Manager?
A provider a member usually doesn't see or choose during a procedure.
What is a Blind Provider?
Modifier: 53
What is Discontinued Procedure?
IPA: CE
What is CIGNA Network Electronic?
What is Observation Stay?
System used to view paper claims.
What is FileNet?
Claims are broken down into two types: ____ or ___.
What is General or Institutional?
Modifier: RR
What is DME Rental?
IPA: CN
What is CIGNA Non-Par Fee Negotiation?