1. Active Coverage: Indicates that a patient’s health insurance is currently valid and active.

2. Authorization: Approval from the insurer for a healthcare service before it is provided.
3. Authorization Frequency: How often the service is authorized, such as once a week or monthly.
4. Authorization Unit Type: Refers to the unit of service, like visits or days, for which authorization is granted.
5. Assigned Provider: The healthcare professional who has been designated to provide care to a patient.
6. Billing Provider: The healthcare provider or entity that submits claims for payment.
7. Billable Notes: Documentation that justifies the billing of a service.
8. Capitation: A payment arrangement where healthcare providers receive a set amount per patient regardless of how many
services the patient uses.
9. Cash Charge: The fee for a service when a patient pays in cash, without using insurance.
10. Claim Appealing Address: The address where patients or providers can send appeals if a claim is denied.
11. Claim Filing Limit: The maximum time allowed for submitting a claim to the insurer.
12. Claim Mailing Address: The address where insurance claims are sent for reimbursement.
13. Coinsurance: A percentage of the cost of healthcare services that the patient is responsible for paying after meeting the
deductible.
14. Component: A part of a service or procedure, often used in billing.
15. Copay: A fixed amount a patient pays for a healthcare service at the time of the visit.
16. CPT Code/Service/Procedure/HCPC Codes: Codes used to describe medical services and procedures for billing purposes.
17. CLIA Number: A certification number for laboratories that perform medical tests, required by the Clinical Laboratory
Improvement Amendments.
18. Deductible: The amount a patient must pay out-of-pocket before the insurance company starts to cover costs.
19. Dx Code: Diagnosis code that describes the medical condition a patient has.
20. Dx Pointer: A code that links the diagnosis to the procedure or service provided.
21. Eligibility: Whether a patient is covered under their health plan for services.
22. EPO: Offers a network of providers but without the need for referrals, though no out-of-network coverage.
23. Enrollment/Admission: The process of registering a patient for healthcare services or enrolling them in a health plan.
24. HCI: Healthcare Industry, referring to the sector that includes hospitals, providers, and insurers.
25. Health Plan: A contract that provides medical coverage and outlines benefits for healthcare services.
26. HMO: Requires members to use a network of doctors and obtain referrals for specialists.
27. IPA: Independent Practice Association, a group of physicians who work together to provide healthcare services under a common
health plan.
28. Insurance Type: The kind of health insurance plan, such as HMO, PPO, EPO, etc.
29. Insured: The person who holds the insurance policy.
30. Insurer: The company that provides the insurance coverage.
31. Interactive Complexity: Factors that make a case more complicated, such as communication difficulties due to mental health
issues.
32. Organization Enrollment: The process of registering an organization, such as a hospital or clinic, with an insurance provider.
33. Modality: The method of delivering treatment, such as in-person, telemedicine, or group therapy.
34. MR Number: Medical Record Number, a unique number used to identify a patient's medical records.
35. Modifier: A code that provides extra details about a service, such as its complexity or the circumstances under which it was
provided.
36. NDC Code: National Drug Code, used to identify prescription medications.
37. NPI: National Provider Identifier, a unique identification number for healthcare providers in the U.S.
38. Patient Statement: A bill sent to a patient that outlines the services they received and the amount they owe.
39. Payer ID: A unique identifier for an insurance company, used for claims processing.
40. PCP: Primary Care Physician, the doctor who provides general medical care and coordinates other healthcare services.
41. POS: Place of Service, the location where healthcare services are delivered (e.g., office, hospital).
42. Preferred Location: The medical facility or location where a patient prefers to receive treatment.
43. Program: A specific healthcare program, such as Medicaid or Medicare.
44. Reauthorization: Renewing the authorization when a service requires additional approval beyond the original timeframe.
45. Rendering Provider: The healthcare professional who actually provides the treatment or service.
46. Referring Provider: The doctor who refers a patient to a specialist or other medical service.
47. Service: The healthcare provided to the patient.
48. Service Location or Facility: The specific place where a patient receives medical care.
49. Service Type: The category of care provided, such as outpatient or emergency services.
50. SSN: Social Security Number, a unique number assigned to U.S. citizens for identification.
51. Supervising Provider: The doctor overseeing the care provided by another healthcare professional.
52. Tax ID: A number used for tax purposes to identify businesses or individuals, such as healthcare providers.
53. Taxonomy Code: A code used to identify a healthcare provider’s specialty or area of expertise.
54. Trigger: An event or condition that prompts the need for a medical service or claim.
55. Types of Health Plans: Various categories of health insurance plans available.
56. UB04: A form used by hospitals to bill insurance for inpatient services.
57. 270 & 271: Electronic transactions for verifying a patient’s health insurance eligibility. 270 is the request, and 271 is the
response.
58. Hospitalization Date: The date a patient was admitted to a hospital.
59. Charge Capture: The process of recording services provided for billing purposes.
60. Charge Master: A hospital’s comprehensive list of services and their associated costs.
61. Eligibility: Whether a patient is covered under their health plan for services.
62. Claim Filing Limit: The maximum time allowed for submitting a claim to the insurer.
63. Claim Mailing Address: The address where insurance claims are sent for reimbursement.
64. Claim Appealing Address: The address where patients or providers can send appeals if a claim is denied.
65. Authorization: Approval from the insurer for a healthcare service before it is provided.
66. Authorization Unit Type: Refers to the unit of service, like visits or days, for which authorization is granted.
67. Authorization Frequency: How often the service is authorized, such as once a week or monthly.
68. Assigned Provider: The healthcare professional who has been designated to provide care to a patient.
69. Billing Provider: The healthcare provider or entity that submits claims for payment.