assignment of benefits patient's written authorization giving the insurance company the right to pay the physician directly for billed charges
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birthday rule used by insurance claims administrators to determine which parents plan will pay for the medical bills of a dependent child when the child is covered by plans of both parents
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capitation rate predetermined amount paid to provider every month regardless of the number of times the patient is seen within the month
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claim written and documented request for reimbursement of an eligible expense under an insurance plan.
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Clean Claim health insurance claim form that has been completed correctly without any errors or omissions
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Clearinghouse independent entity that reviews claims, requests clarification from the provider, and "cleans" claims, ensuring accurate information is documented, then submits claims to insurance companies in proper format
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CMS-1500 most common health insurance claim form used to file claims for physicians services
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Co-Insurance cost of claims shared by insurance company and insured after deductible
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Coordination of Benefits procedures to prevent duplication of payment by more than 1 insurance carrier
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Co-Payment predetermined amounts of money the patient must pay for medical services at every visit, as determined by the insurance company.
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Crossover Claim patient claIM THAT IS ELIGIBLE FOR BOTH MEDICARE AND MEDICAID; ALSO KNOWN AS MEDI/MEDI
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Deductible amount of eligible charges each patient must pay each calendar year before the insurance plan begins to pay benefits
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denied claim occurs when procedures or services are not covered by the patient's insurance policy or when the patient has not met his or her deductible
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Dirty Claim a health insurance claim form that is incorrectly because it has missing data or errors
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Disability