Medical Insurance Claim Terms

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Glossary of billing and insurance terms - Mayo Clinic

https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/glossary

DSGs are a system of classifying inpatient stays for payment. The Centers for Medicare & Medicaid Services uses DSGs to derive standard reimbursement rates for medical procedures and to pay hospitals for Medicare recipients. Some states use DSGs for all …

Common Health Insurance Terms and Definitions | WPS

https://www.wpshealth.com/resources/customer-resources/health-insurance-terminology.shtml

Allowable charge—sometimes known as the "allowed amount," "maximum allowable," and …

Claim - Glossary | HealthCare.gov

https://www.healthcare.gov/glossary/claim/

Claim A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered. Resources About the …

Medical Claims 101: What You Need to Know - Definitive …

https://www.definitivehc.com/blog/medical-claims-101-what-you-need-to-know

A medical claim is a bill that healthcare providers submit to a patient’s insurance provider. This bill contains unique medical codes detailing the care administered during a patient …

Glossary of Health Insurance Terminology Explained in …

https://www.goodrx.com/insurance/health-insurance/terminology-glossary

Medicaid provides free or low-cost health insurance to certain groups including low-income families and children, pregnant …

Health Insurance Terms Glossary – Forbes Advisor

https://www.forbes.com/advisor/health-insurance/health-insurance-terms/

A health insurance deductible is a fixed amount an insured person pays out-of-pocket in a year before the insurance company covers its portion of qualifying medical expenses. After you pay...

Your Simple Guide to Understanding the (Not-So …

https://www.anthem.com/blog/health-insurance-basics/health-insurance-claims-process/

What is a Claim? Simply put, a claim is what a doctor submits to your insurance company so they can get paid. It shows the medical services that were …

Understanding Your Explanation of Benefits (EOB)

https://www.verywellhealth.com/understanding-your-eob-1738641

An explanation of benefits (EOB) is a document that a health plan sends to a member after a medical claim is processed. The EOB will show a variety of information, including details about the …

Medical Billing Vocabulary & Key Terms

https://www.medicalbillingandcoding.org/billing-vocabulary-key-terms/

The process by which a patient or provider attempts to persuade an insurance payer to pay for more (or, in certain cases, pay for any) of a medical claim. The appeal on a claim only occurs after a claim has …

Common Health Insurance Terminology 101 - JDRF

https://www.jdrf.org/t1d-resources/living-with-t1d/insurance/common-health-insurance-terms/

Common Health Insurance Terminology 101. Allowed Amount/Allowed Charges. When insurance companies contract with a doctor, hospital, pharmacy or medical equipment …

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