People
All About the $$
Coverage
Terms You Need to Know
Acronyms
100
****WILDCARD****
The name of our ECU mascot.
What is Pee Dee Pirate?
100
A contracted, pre-determined, dollar amount insurance company requires a patient to pay upfront for a particular medical service. It aids in deterring people from seeking medical care that may not be necessary.
What is a copay?
100
A specific package of benefits negotiated between the company and the employer.
What is plan?
100
The pathway a patient takes from one provider to another. May be required by insurance before a patient can be seen by the other provider.
What is referral?
100
This is what EPIC is.
What is EHR, or Electronic Health Record?
200
A person entitled to health insurance benefits under the subscriber's plan.
What is a covered member, or member?
200
A pre-determined annual amount patient must pay before insurance begins to cover.
What is a deductible?
200
Insurance Company; may offer several different plans.
What is payor?
200
The process whereby a physician must obtain insurance approval before a patient receives certain treatment or drugs (study, test, procedure, surgery.)
What is authorization?
200
Coverage that ECUP is not in contract with.
What is OON, or Out of Network?
300
Referred to as a family doctor, this person administers routine and preventive care, and makes referrals for specialty services when needed.
What is a Primary Care Provider, or PCP?
300
A contracted, pre-determined percentage of the allowable charge that a patient is required to pay for a particular medical service (after the deductible is met and before the out-of-pocket max is met).
What is coinsurance?
300
A contract with a company where the subscriber pays a regular premium in exchange for a defined set of benefits.
What is health insurance?
300
The order in which the claim is sent to insurance companies. (If patient has more than one insurance plan, we must determine which insurance should be billed primary, secondary, etc. Primary: the first insurance company designated to pay toward their allowable charges. Secondary: the second insurance company designated to pay toward their allowable charges.)
What is filing order?
300
A statement from the insurance company that details payments and adjustments made for services. These go to both the provider and the patient
What is EOB?
400
A provider who focuses on one area of medicine, such as a cardiologist or neurologist.
What is a specialist?
400
Annual maximum amount patient is required to pay for in-network medical services per his/her insurance plan contract (typically, copay + coinsurance + deductible).
What is out-of-pocket?
400
****WILDCARD****
This is the common reason most historical pirates wore eye-patches.
What is to help keep one eye adjusted to night vision for seeing below deck? (So when they would go below deck they could swap the eye patch from one eye to the other and see with the eye that has already adjusted to low light conditions. This would allow them to instantly see in the dark.)
400
Response from the insurance company that states no payment will be made. (service could be not covered by the insurance plan, or the insurance company may need more information.)
What is a denial?
400
Document, document, document! When being trained, this acronym is used to remind you of why everything done in EPIC should be thoroughly documented.
What is CYA, or... Cover... Your...
500
The person who is responsible for payment of the monthly premium, or whose employment is the basis for coverage.
What is a subscriber?
500
The contracted rate a health insurance company will pay toward a specific medical service.
What is allowable charges?/allowed amount?
500
Dates during which the insurance plan is active.
What are effective dates?
500
****WILDCARD***
To provide the highest quality and most compassionate health care to the people of eastern North Carolina while educating the next generation of health professionals to do the same.
What is ECUP's Core Purpose?
500
Approved by Congress to protect the privacy of patients and insure that patients have access to their medical files.
What is HIPAA, or Health Insurance Portability and Accountability Act?