Definitions Flashcards
Premium
Amount policy holder pays for benefits
Benefits
Payments for medical services for a specific time period
Dependents
Spouse or children
Clearinghouse
They scrub or clean claims to ensure correct coding
Deductible
Annual fixed dollar amount to be paid by policy holder in addition to premium
Coinsurance
Fixed percentage of covered charges after deductible is met
Copayment
Fixed fee collected at the time of service
Birthday Rule
Plan of the person who’s birthday comes first is the primary
Precertification
Process of confirming with insurance that specific services are covered under the plan
Preauthorization
Confirmation that insurance will consider “covered service”
Fee Schedule
List of usual prices
Fee For Service
Pay provider for all services based on the fee schedule
Allowed Charge
Maximum amount a plan will pay a provider
Diagnosis Code
Primary condition for which a patient is being treated
