Revenue Abbreviations
CDM stands for
What is Charge description master?
RA stands for
What is remittance advice?
The amount of cost, usually annually, the policyholder must incur before the plan will assume liability for the remaining covered expenses
What is deductible?
NDC stands for
What is national drug code?
Precertification/Authorization/Notification Absent
What is denial code 197?
FFS stands for
What is fee for service?
PPO stands for
What is Preferred provider organization?
A pre-established percentage of eligible expenses after the deductible is paid
What is coinsurance?
Hospital claim form
What is a UB04?
Eagle code for when a payment or denial is posted and the claim balance is held for review
What is OC44?
COB stands for
What is coordination of benefits?
HMO stands for
What is Health Maintenance organization?
A three digit code linked to every charge
What is a revenue code?
System to determine if a patient's health plan is valid for Medicaid
What is EMEVS or EPACES?
Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor
What is denial code 109?
PFS stands for
What is patient financial system and/or patient financial services?
CMS stands for
What is Centers for Medicare and Medicaid Services?
A list of services and the amount that the healthcare insurance plan will pay for healthcare claims
What is a fee schedule?
Reg Area responsible for treating students at offsite clinics
What is School Based?
These are non-covered services because this is not deemed a "medical necessity" by the payer
What is denial code 50?
RCM stands for
What is revenue cycle management?
MCO stands for
What is Managed care organization?
A form that details how the payer processes the claim for payment sent to the patient
What is an EOB?
Department responsible for submitting clinical information to the insurance company
Who is case management?
Charges exceed your contracted/legislated fee arrangements
What is denial 45?