ch.3 & 7 AOP
Terms
undefined, object
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- member
- person covered under an insurance program's contract
- rejected claim
- an insurance claim submitted to an insurance carrier that is discarded by the system because of a technical error or because it does not follow medicare instructions
- guarantor
- an individual who promises to pay the medical bill by signing a form agreeing to pay or who accepts treatment which constitutes an expressed promise
- invalid claim
- any medicare claim that contains complete, necessary information but is illogical or incorrect
- pending claim
- an insurance claim held in suspense because of review or other reason
- clean claim
- a completed insurance claim form submitted with the program time limit that contains all the necessary information without deficiencies so it can be processed and paid promptly
- coinsurance
- a cost-sharing requirement under a health insurance policy providing that the insured will assume a percentage of the costs for covered services
- eligibility
- qualifying factors that must be met before a patient receives benefits under a specified insurance plan, government program, or managed care plan
- applicant
- a person applying for insurance coverage
- dirty claim
- a claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment