Medical Billing

Payers

100

The Mother of Rules

Medicare

200

Heath Maintenance Organizations require this 

Primary Care Physicians or PCP

300

Insurance company decides on whether a procedure is covered and under which circumstance

Coverage Determination

400

Injured on the job 

Workers Comp

500

Payer of last resort

Medicaid

Claim Terms

100

Facility charges are billed on these

UB-04

200

ICN

Internal Control Number

300

The organization used to "scrub" a claim to check for errors and then electronically transmit claim information 

Clearinghouse

400

NPI

National Provider Identifier

500

DRG

Diagnosis related group

EOB

100

Adj

Adjustment

200

Insurance payment + Patient Liability

Allowed Amount

300

CO-29

Timely filing denial

400

PR-96

Non-covered charge that has been applied to the patient

500

Gives the reason why a claim or CPT code was denied

Claim Adjustment Reason Code or CARC

Medicare

100

A notice given to patients to indicate that Medicare is not likely to pay for a specific service and the patient would be responsible for those charges

Advance Beneficiary Notice (ABN)

200

MBI

Medicare Beneficiary Identifier

300

This part pays for inpatient charges, hospice, SNF, home health

Part A

400

Medicare Optional Plan

Medical Supplemental Insurance

500

All reasons why someone under 65 would qualify for Medicare

Disability & ESRD

Misc

100

COB

Coordination of Benefits

200

Any information in a medical record that can be used to identify an individual

PHI

300

Gives the reason why a claim or CPT code was denied

Claim Adjustment Reason Code or CARC

400

I am responsible for auditing accounts for all reps on a team. I identify problems, look for trends and suggest recommendations for improvement

Quality Control Analyst (QC Rep or Analyst)

500

DPD is the abbreviation for this 

Detailed Procedure Document