Insurance and medical coding

3. claim, a claim held or rejected by the insurance car- rier due to problems or errors
6. provides health insurance coverage for children under 19 years of age in families who are not eligible for Medicaid but can- not afford private coverage
7. payment made to a provider based on a fixed amount per enrollee assigned to that provider regardless of services provided
8. using several CPT codes to identify proce- dures normally covered by a single code
9. 1500, universal health insurance claim form used in the physician's office
10. claim, completed insurance claim form submitted to a carrier without deficiencies or errors
11. a bill sent to the insurance carrier for payment re- lated to patient care

1. rule, a method used to determine the primary insurance carrier when children are covered under both parents' insurance plans; the parent whose birthday falls earliest in the calendar year becomes the primary carrier
2. under health plans, individuals are required to receive advance authorization from the insurance provider for particular medical services; usually required for re- ferral to a physician specialist
4. a set amount owed by the insured at the time of is waiving of co-payment by the medical office is against federal guidelines for Medicare and Medicaid; sometimes referred to as co- insurance which is not correct
5. coding system first published by the American Medical Association in 1966; a manual, updated annually, that contains the codes for procedures and services performed by doctors and other select medical personnel
6. a percent of the covered insurance payment owed by the individual to the provider for the service
8. deliberately using an incorrect code to bill at a higher rate
10. a service benefit program with no premiums for select family members of specific, usu- ally not retired, veterans