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Definition
| Authorization by policyholder that allows a health plan to pay benefits directly to a provider. |
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| The portion of charges that an insured person must pay for health care services after payment of the deductible amount;usually stated as a percentage. |
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An amount that an insured person must pay, usually on an annual basis, for health care services before a health plan's payment begins. |
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Definition
| A physician's opinion of the nature of patients' illnesses or injuries. |
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Definition
| A health care claim that is transmitted electronically; also known as an electronic media claim (EMC). |
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Definition
| Standards of conduct based on moral principles. |
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Term
| Explanation of benefits (EOB) |
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Definition
| A document from a payer sent to a patient that shows how the amount of a benefit was determined. |
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Definition
| An electronic transaction or a paper document filed with a health plan to receive benefits. |
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Definition
An insurance company's agreement to reimburse a policy holder a predetermined amount for covered losses. |
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Term
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Definition
Health plan; also known as insurance company, payer, or third-party payer. |
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