Insurance Vocabulary
The dollar amount a clinic, facility or doctor is able to charge for a service
What is the allowed amount?
Set dollar amount collected at the OV.
What is a Copay?
Stands for preferred provider organization allows the insured to see any doctor within the network.
What is a PPO?
DX code
What is Diagnosis code?
International Classification of Diseases
ICD (10)
Obtaining this is required by some insurance companies before they will pay for a service or item.
What is an authorization?
Amount collected by the guarantor before the insurance company starts to share the cost of certain services or equipment.
What is the deductible?
Health maintenance organizations, must have an assigned PCP and referrals if a specialist is needed.
What is an HMO?
CPT
What is Current Procedural Terminology?
Electronic Data Interchange
What is EDI?
List of services, items and medications that is offered through an insurance plan
What are the benefits of the insurance plan?
When the deductible met this amount is collected by the patient.
What is the coinsurance?
Also known as Biden care plans once Obama Care. These plans were designed to help those who cannot other obtain health insurance through work or qualify for MCD.
What is a QHP?
EOB
What is Explanation of benefits?
Treatment
TX
Medicaid is an example of this type of insurance
What is a third party administrator?
type is visit is usually covered at 100% once a year
What is a preventative or wellness visit ?
State funded insurance for low-income families also a third-party administrator.
What is Medicaid ?
RA
What is remittance Advice?
Prescription
Rx
When dependent is covered by both mom and dad. This is used to determine the primary and secondary policy
What is the birthday rule?
Amount that once met the insurance company covers 100% of the cost for services rendered until the end of the plan year.
What is the OOP (out of pocket)?
Usually, an individual must be at least 65 or older to have this plan, may also be disabled.
What is Medicare?
HCPCS
What is Healthcare Common Procedure Coding System?
Centers for Medicaid and Medicare Services