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Insurance Ch. 9 Vocab

Terms in this set (16)

Appeal
Request for a review of an insurance claim that has been underpaid or denied by an insurance company to receive additional payment is called a/an
Explanation of benefits
A document that describes services billed and details payment determinations is known as
overpayment
To receive more than the amount due from the insurance carrier or patient is called
Two party check
A check that is made out to the provider of services and to the patient by the maker (writer) of the check is called a
rebill or resubmit
To send another request for payment for an overdue bill to either the insurance company or the patient is known as a/an
peer review
Analysis of a patient's case by one or more physicians using federal guidelines to evaluate another physician in regard to quality and efficiency of medical care rendered is called
denied claim
Insurance claim submitted to an insurance company in which payment has been rejected because of a technical error or medical coverage policy issues
delinquent claim
Insurance claim submitted to an insurance company for which payment is overdue
suspended claim
Insurance claim that is processes by the insurance carrier but is held in an indeterminated (pending) state regarding payment because of either an error or the need for additional information
lost claim
Insurance claim that cannot be located after sending it to an insurer
rejected claim
Insurance claim submitted to an insurance carrier that is discarded by the system either because of a technical error or because it does not follow the insurance plan's instructions
denied paper or electronic claim
An insurance claim submitted to an insurance company in which payment has been rejected owing to a technical error or because of medical coverage policy issues
tracer
An inquiry made to an insurance company to locate the status of an insurance claim
remittance advice
A document detailing services billed and describing payment determination issued to providers of the Medicare or Medicaid program; also known in some programs as an explanation of benefits
review
To look over a claim to assess how much payment should be made
suspense
The pending indeterminate state of an insurance claim because of an error or need for more information
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