Term
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Definition
| plan covering the male is the primary and plan covering the female is secondary. |
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Term
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Definition
| Applied to both medical and dental charges combined, all savings kept intermingled. |
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Term
| Partial Credit adjustment |
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Definition
| an adjustment that partially reverses a claim payment. |
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Term
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Definition
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Term
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Definition
| Surgical puncture of the cul de sac. |
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Term
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Definition
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Term
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Definition
| Dialation and curretage. scraping of the uterine lining by entering the cervix. |
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Term
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Definition
| Male or female reproductive organs. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| incision into the uterus. |
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Term
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Definition
| Intra uterine Device. A device placed in the uterus to help the prevention of pregnancy. |
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Term
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Definition
| Surgical removal of the ovary. |
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Term
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Definition
| condition of the lack of one or both testicles. |
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Term
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Definition
| Artificial placement of semen into the vagina. |
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Term
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Definition
| condition were semen lacks spermatozoa. |
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Term
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Definition
| inflammation of penis glands. |
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Term
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Definition
| Benign prostate hyperplasia. |
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Term
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Definition
| removal of testies in a male or ovaries in a female. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| narrowing of the opening of the prepuce, the foreskin cannot be pulled back over glans penis. |
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Term
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Definition
| inflammation of the prostate. |
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Term
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Definition
| prostate specific antigen cancer screening. |
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Term
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Definition
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Term
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Definition
| an agent that kills sperm. |
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Term
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Definition
| Transurethral resection of the prostate. |
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Term
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Definition
| an adjustment that completely reverses a claim payment. |
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Term
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Definition
| Files for holding claims and other processing information. |
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Term
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Definition
| Files which are kept in batches or groups based on the date they were processed and the person who processed them. |
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Term
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Definition
| Determines whether the estimated length of time and scope of the inpatient stay is justified by the diagnosis and symptoms. |
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Term
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Definition
| Surgery recommended as an elective procedure when an alternative method of treatment may be preferable for a number of reasons. |
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Term
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Definition
| An estimate of maximum benefits that may be paid by under the plan for the services. |
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Term
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Definition
Preapproval for admission on elective, nonemergency hospitalization.
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Term
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Definition
| allowable amount for that particular procedure assigned according to the particular CPT code. |
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Term
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Definition
| A dollar amount determined for a specific service type or a particular region . Each region may have a unique set of conversion factors, and service type may be assigned a specific conversion factor. |
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Term
| Common Accident Provision |
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Definition
| a provision whereby only one deductible is taken for all members of a family involved in the same accident. |
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Term
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Definition
| The right for a portion of the recovery that the claimant may obtain from a third party. |
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Term
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Definition
| Insurance that covers plans when their benefit payments exceed a certain amount. |
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Term
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Definition
| An insurance that would reimburse the employer when losses exceed a specific amount agreed on by the employer and the reinsurance carrier. |
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Term
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Definition
| A person or entity buying insurance or maintaining coverage for the purpose of making a profit. |
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Term
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Definition
| Like or similar coverage. For example if the former coverage was medical only, and the new coverage is medical, dental, and vision only the medical portion would be considered credible. |
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Term
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Definition
| This limit stipulates that if the coinsurance amount reaches a certain level, all subsequent claims will be paid at 100% of the allowed amount. |
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Term
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Definition
| Means that any amounts which the patient pays toward their deductible in the last three months of the year will carry over and will be applied toward the next year's deductible. |
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Term
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Definition
| compenstion for an insured person for all of the actual losses or damages to make that person whole again. |
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Term
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Definition
The person who receives payment on a claim, often the person who receives the benefit in the case of a deceased member.
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Term
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Definition
| An item covered by an insurance policy, or something paid to or on behalf of a recipient. |
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Term
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Definition
| Any amounts paid toward the deductible by any member of the family will be added up to reach the deductible. |
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Term
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Definition
| Studies that an insurance company uses, for a carrier which covers health insurance, these can include statistics covering average life span, number of days in hospital per year for each age group, number of doctor visits, cost of all medical services, etc. |
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Term
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Definition
| Pathological condition in which endometrial tissue has been displaced to various sites in the abdominal and pelvic cavities. |
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