|
Acronym |
Term |
Definition |
| 835 File | Electronic ERA File | |
| 837 File | Electronic EDI File | |
| Adjudication | Insurance company’s process of determining what to pay you and why | |
| Adjustment | Mandatory “write-off” determined by an insurance company |
|
| Billing Provider | Who is getting paid for the rendered service (Box 33 on the CMS-1500) | |
| Classes | A flexible way to define sessions, clients, or payments | |
| Contracted Rate | Predetermined reimbursement rate for a service (i.e. what insurance pays you) | |
| COB | Coordination of Benefits | Coordination of benefits (COB) allows plans that provide health coverage to determine their respective payment responsibilities (i.e. determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan). |
| Credentialing | The process of obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a healthcare organization. | |
| CPT Code | Current Procedural Terminology | A billing code that represents either a procedure or supply. |
| DOS | Date of Service | The date the insured was seen by a healthcare practitioner or given medical treatment. |
| Diagnosis Pointer | Indicates what diagnosis code you were treating with which CPT | |
| EDI | Electronic Data Interchange | The electronic interchange of business information using a standardized format; a process which allows one company to send information to another company electronically rather than with paper. |
| EFT | Electronic Funds Transfer | Electronic funds transfer (EFT) is the electronic transfer of money from one bank account to another, either within a single financial institution or across multiple institutions, through computer-based systems and without the direct intervention of bank staff. |
| ERA | Electronic Remittance Advice | An electronic remittance advice (ERA) is an electronic data interchange (EDI) version of a medical insurance payment explanation. It provides details about providers' claims payment, and if the claims are denied, it would then contain the required explanations. |
| EOB | Explanation of Benefits | An explanation of benefits is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. The EOB is commonly attached to a check or statement of electronic payment. |
| CMS-1500 | The standard paper claim to bill the Centers for Medicare and Medicaid services for reimbursement for services provided by patients. | |
| HL-7 | Health Level 7 | Format in which the WebPT Data comes to Therabill |
| Payer | Insurance company | |
| Provider | Therapist | |
| Remark Code | Code explaining why insurance company adjudicated the service a certain way | |
| Rendering Provider | The therapist who performed the service (Box 24J on the CMS-1500) | |
| Secondary | A second Insurance Plan | |
| Service Code | A valid CPT Code | |
| Service Facility | The location where the service(s) took place (Box 32 on the CMS-1500) | |
| Session | A Date of Service | |
| TIN | Tax ID Number | The Billing Provider's Federal Tax ID (Box 25 on the CMS-1500) |
| Taxonomy Code | Identifies the provider’s specialty | |
| Tertiary | A third insurance Plan |
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