Medical Terminology
Someone admitted to the hospital for overnight stay.
In-Patient or IP
Refers to a 12-month period of benefit coverage
Plan Year
The maximum amount of money the insurance plan will pay toward the member's claim.
Allowed Amount
Two ways a note can be accessed
Member Screen or F6
Area to locate deductibles and out of pockets.
Accumulators
This is considered ambulatory care.
Out-Patient or IP
Order from a PCP to see a specialists
Referral
The screen that shows general payment information.
Voucher
3 points of identification
Member ID
Member's Name
Members Date of Birth
*SSN (Last resort)
Area to locate benefit grids
Correspond
A injury or illness occurring prior to effective date of insurance.
Pre-Existing
Grid section (number) that lists benefits for DME
Section 20
Area on the Claim Screen you can find the name of the network.
Repricing Flag or Adj Details
Area that shows what the note is about.
Note Properties
Area that indicates the employee
Date of Hire or Subscriber Name
Suffix that relates to a medical image.
graphy, graph, gram
Section # of the Benefit Grid that lists the member's effective date.
Section 3
The difference between the Charge Amount and the Contract Amount.
Write Off
Information always required on a note.
Caller, Phone Number, Member ID, Group #
Area that lists the member's coverage
Eligibility
Medical word that ends in "itis" refers to.
Inflammation
Section of the grid that will list benefits in alphabetical order
Section 28 - Covered Expenses: Medical
Two areas where you can locate the patient's responsibilty.
Claim and Claim Search Result screen
Item that is used to capture caller's information
Standard Template or Template
Area to locate pre-authorizations.
Referrals