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Health Insurance Chapter 3

Terms in this set (25)

Acknowledgment of Receipt of Notice of Privacy Practices
Form accompanying a covered entity's Notice of Privacy Practices
Adjustment
Change to a patient's account
Assignment of Benefits
Authorization allowing benefits to be paid directly to a provider
Certification Number
Identifying code assigned when preauthorization is required
Charge Capture
Procedures that ensure billable services are recorded and reported for payment
COB
Coordination of Benefits. explains how an insurance policy will pay if more than one policy applies
Financial Policy
Practice's rules governing payment from patients
Gender Rule
Coordination of benefits rule for a child insured under both parents' plans
Guarantor
Person who is the insurance policyholder for a patient
HIPAA Coordination of Benefits
Transaction sent to a secondary or tertiary payer
HIPPA Eligibility for a Health Plan
Transaction in which a provider asks for a receives an answer about a patient's eligibility for benefits
NonPar
Nonparticipating Provider
PAR
Participating Provider
Primary Insurance
Health plan that pays benefits first
Prior Authorization Number
Identifying code assigned when preauthorization is required
RTCA
Real-time claims adjudication. process used to generate the amount owed by a patient
RCM
Revenue Cycle Management. The actions that ensure the provider receives the maximum appropriate payment
Supplemental Insurance
Health plan that covers services not normally covered by a primary care plan
Tertiary Insurance
Third payer on a claim
Trace Number
Number assigned to a HIPAA electronic transaction
MCO
Managed Care Orginization
TOS
Time-of-Service
Referral Waiver
document a patient signs to guarantee payment when a referral authorization is pending
PDA
Personal Digital Assistant
Walkout Receipt
Report that lists the diagnoses, services provided, fees, and payments received and due after an encounter
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