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The funds owed to the provider, as determined and fixed by the agreed insurance policy. A fixed dollar amount that must be paid or “met” once a year, in addition to the premium, before the third-party payer begins to cover medical expenses.
WHAT IS ATD?
When an insurance provider contacts another to see if they’re currently providing specific coverage.
WHATS IS DCI
An explanation of what the insurance company provides, usually consisting of covered charges, payment methods, deductibles, patient responsibility and potential write-offs.
EOB
INN STANDS FOR?
In-Network
A medical care provider that is contracted with the specific insurance provider used by a patient
PPO stands for?
Preferred Provider Organization
A network of medical care providers that patients are allowed to visit, as determined by the insurance agency.
Funds paid directly to the medical provider. The provider agrees to prepare healthcare claims for patients, to receive payments directly from the payers, and to accept a payer’s allowed charge
WHAT IS AOB?
The electronic network that collects information before delving it out to particular individual insurance providers
EDI
FDCPA STANDS FOR?
Fair Debt Collection Practices Act
Law explaining the guidelines for creditors and collections agencies trying to collect from delinquent accounts
IPA IS THE ACRONYMS FOR?
Independent Practice Association
The group of medical care providers contracted with an HMO plan.
Basic patient information that remains classified, usually consists of name, date of birth, social security number, insurance ID, medical records and telephone numbers.
what is PHI
BCBS IS FOR?
Blue Cross Blue Shield
A group of affiliated medical insurance for-profit companies that provide health insurance for a fee to individuals or groups. The largest group of non-government insurance companies that offer multiple products. Blue Cross and Blue Shield is the most widely known.
The electronic network that collects information before delving it out to particular individual insurance providers.
EDI
The Medicare official that handles Medicare claims and cases
WHAT IS FI.
A healthcare service that is not covered by the insurance policy.
IS KNOWN AS N/C.
TIN stands for?
Tax Identification Number
The specific number assigned to an individual for tax filing and tracking purposes.
COB STAND FOR?
Coordination of Benefits
Essentially which insurance agency is the primary provider and which is the secondary when a patient has more than one policy.
EFT STANDS FOR?
Electronic Funds Transfer
Transferring money electronically. A credit or debit charge or transfer must take place.
The “privacy” rule of the health industry that outlines the use and or distribution of personal health information for specific organizations
WHAT IS HIPAA?
NEC STANDS FOR
The abbreviation used on ICD forms when the information given does not permit a more refined assignment
The cafeteria-style insurance plan that offers a choice of HMO, PPO or traditional insurance policies. Includes a MSA (medical savings account)
what is TOP?
DOS STANDS FOR?
Date of Service.
When the service took place.
Digitally formatted health records; the complete record of a patient that is sent to a healthcare provider and/or insurance agency
WHAT IS EMR
A healthcare policy that requires a gatekeeper or primary care physician. If a situation calls for further action, this gatekeeper will refer the patient to a different specialist.
WHAT IS HMO?
acronyms know as OON stand for?
Out of Network
A medical service provider that does not currently work with the specific insurance company.
UCR stands for
Usual Customary & Reasonable
The coverage limitations set in place by an insurance. Limits the maximum amount of funding a company will pay for a service.