A company that receives claims from a provider, prepares them for processing, and transmits them to the payers in HIPAA-compliant format.
Private or government organization that insures or pays for health care on behalf of beneficiaries.
Payment to a provider that covers each plan memeber's health care services for a certain period of time.
payment or reward (especially from a government) for acts such as catching criminals or killing predatory animals or enlisting in the military
A system that combines the financing and the delivery of appropriate, cost-effective health care services to its members.
Explanation of Benefits
A recap sheet that accompanies an insurance checks showing the breakdown and explanation of payments on a claim.
a report from a clearinghouse that lists errors to be corrected before a claim can be submitted to the payer
Preferred Provider Organization
A managed care organization structured as a network of health care providers who agree to perform services for plan members at discounted fees; usually, plan members can receive services from non-network providers for a higher charge.
Patient Information Form
Form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim.