HCMA 115 Week 2 Terminology

Assignment of Benefits

• The most amount of money allowed for a procedure or service

• Number used by the IRS to identify a business for income tax reporting

• Promise to take Insurance payment as payment in full

Beneficiary

• Person entitled to receive benefits

• An approval for a procedure or a referral

• The monthly, quarterly or annual payment of money to an insurance company for providing certain benefits

Employer Identification Number EIN

• Amount that must be paid out of pocket before the insurance company begins to pay

• Number used by the IRS to identify a business for income tax reporting

• Insurance that covers a group of people with a single contract through employer

Medigap

• A term sometimes applied to private insurance products that supplements Medicare insurance benefits

• An approval for a procedure or a referral

• An insurance claim form without errors or omissions

Universal Claim Form

• A form made by the Health Care Financing Admin.(now CMSI center for Medicare and Medicaid Services) to submit all Gov't sponsored claims

• An insurance claim form without errors or omissions.

• A term used for all healthcare plans that provide healthcare in return for a monthly fee using a set group of primary care doctors and hospitals.

Allowed Charge

• A term used for all healthcare plans that provide healthcare in return for a monthly fee using a set group of primary care doctors and hospitals

• The most amount of money allowed for a procedure or service.

• Amount that must be paid out of pocket before the insurance company begins to pay.

Authorization

• Insurance against liability employers pay to give benefits to workers who injured or killed on the job.

• The monthly, quarterly or annual payment of money to an insurance company for providing certain benefits

• An approval for a procedure or a referral

Utilization review

• When a case is reviewed to see if services are needed and if medical resources are used.

• A form made by the Health Care Financing Admin.(now CMSI center for Medicare and Medicaid Services) to submit all Gov't sponsored claims.

• Things, diseases, conditions on an insurance contract for which benefits are not paid.

Managed Care Plans

• Amount that must be paid out of pocket before the insurance company begins to pay

• A term sometimes applied to private insurance products that supplements Medicare insurance benefits

• A term used for all healthcare plans that provide healthcare in return for a monthly fee using a set group of primary care doctors and hospitals.

Premium

• The monthly, quarterly or annual payment of money to an insurance company for providing certain benefits.

• Health Maintenance Organization

• Claims are returned unpaid to the provider for clarification of any questions and must be corrected before resubmission.