Displays the undistributed credits and charges that are on the account.
What is the Professional Inquiry Tab?
100
The amount that an insurance policy holder has to pay out-of-pocket before the insurer begins paying.
What is a Deductible?
100
Centers for Medicare and Medicaid Services.
What is CMS?
100
Any agency that contracts with healthcare organizations and patients to pay for the care of covered patients.
What is a Third Party Payor?
200
An encounter grouper for charges in Hospital and Professional Billing.
What is a Hospital Account Record (HAR)?
200
Area to view the Professional Billing transactions for the current HAR.
What is the Professional Transaction Inquiry Tab?
200
An overpayment or adjustment performed on an account causing the balance to fall below zero.
What is a Credit Balance?
200
The statement sent to an insured and the provider by their health insurance company listing services provided, amount billed, eligible expenses and payment made by the health insurance company.
What is the EOB (Explanation of Benefits)?
200
The system voiding and reposting charges based on insurance coverage changes.
What is Retro Adjudication?
300
Holds transactions that are assigned to Resolute Hospital Billing for an admission or visit.
What is HB HAR?
300
Displays an overall view of the guarantor’s account in a sectioned format.
What is the Guarantor Summary Tab?
300
Billing for multiple services that are mutually inclusive (such as blood testing and drawing blood) under one code.
What is Bundling?
300
A listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians.
What are CPT (Current Procedural Terminology) codes?
300
The activity used to summarize all of the actions taken while working a claim.
What is a Note?
400
A record that is created by the system during check in, manual charge entry, or when charges are in the Charge Router.
What is a PB HAR?
400
Displays basic information about an account, such as the account status, coverage, or details about claims or statements sent on the Guarantor Snapshot.
What is the Professional Snapshot Tab?
400
A group of services that are normally billed under one code are separated out and billed individually by service code.
What is Unbundling?
400
A health benefit design that provides members with higher levels of benefits when care is managed by a Primary Care Physician (PCP).
What is POS (Point of Service)?
400
A claim that can be processed without obtaining additional information from the provider of the service or from a third party.
What is a Clean Claim?
500
Houses only professional payment and credit adjustments.
What is the Default HAR?
500
An Area to view, edit, create, activate, and deactivate payment plans.
What is the Payment Plan Tab?
500
A method of payment for health services in which a physician or hospital is paid a fixed, per capita amount for each person served regardless of the actual number of services provided to each person.
What is Capitation?
500
Most group health plans contain a provision, which requires that when a member is covered by two or more group health plans, payment will be divided between them so the combined coverage will pay up to 100% of allowable expenses.
What is COB (Coordination of Benefits)?
500
A temporary contracted physician, usually filling in for an absent doctor on staff.