Terms
Terms
Terms
Abbreviations
Abbreviations
100
amount charged by the practice when providing services
What is actual charge?
100
another name for an insurance company that covers health services
What is carrier?
100
amount a patient must pay before the insurance company will pay on claim
What is deductible?
100
EOB
What is explanation of benefits?
100
IME
What is independent medical examiner?
200
method of settling legal dispute involving a third party to render the decision for settlement
What is arbitration?
200
pre-approval from the insurance company of all elective services; essential in reimbursement
What is pre-certification?
200
process of taking a witnessis sworn testimony by an attorney outside the courtroom
What is deposition?
200
CF
What is conversion factor?
200
PPO
What is preferred provider organization?
300
assessing medical services to assure quailty, necessity and appropriateness of treatment
What is utilization review?
300
contracted individual or organization tha holds agreement with patient to help cover health care costs
What is third party payer?
300
a compensable injury for an employee hired in one state but injured in another state
What is extraterritorial?
300
COB
What is coordination of benefits
300
WC
What is worker's compensation?
400
the amount an insured must pay at time of service toward the amount allowed by the insurance company
What is co-payment?
400
statement sent by the insurance company to the physician detailing clims processing and payments
What is remittance advisory?
400
one who supplies healthcare services
What is a provider?
400
DOS
What is date of service?
400
BR
What is by report?
500
a physician that practices in an area other than primary care
What is a specialist?
500
ranking of fees from all providers in a area to develop a reimbursement base
What is percentile?
500
form of pre-payment to the provider that has agreed to service members in an insurance program
What is capitation?
500
HMO
What is health maintenance organization?
500
civilian health and medial program of the uniformed services
What is TRICARE?
M
e
n
u