MBC terminology A-H

services a patient requires in a hospital setting that are in addition to room and board accommodations

• ancillary
• axillary
• auditory

When an insurance plan does not pay for treatment, an appeal (either by the provider or patient) is the process of objecting this decision. 

• adjust
• appeal

Insurance payments that are paid to the doctor or hospital for a patient's treatment.

• premium
• assignment of benefits

A fixed payment paid per patient enrolled over a defined period of time, paid to a health plan or provider.

• capitation
• beneficiary

a service that transmits claims to insurance carriers. Prior to submitting claims the clearinghouse scrubs claims and checks for errors. 

• clearinghouse
• transmission claim

​a responsible party and or insured party who is not a patient

• guarantor
• provider

claim that has all the necessary correct information without any omissions or mistakes that allows it to be processed and paid promptly.

• clearinghouse
• clean claim

referring to the unpaid insurance claims or patient balances that are due past 30 days.

• medicare
• aging 
• ABN

 Centers for medicare and medicaid services

• CMS
• CMS-1500
• CNS

Medical claim form established by CMS to submit paper claims to Medicare and Medicaid. Most commercial insurance

• cts 1500
• cms 1500