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Glossary

Ancillary Service
A service that supports your main visit or medical service. Examples: laboratory, radiology, pharmacy, radiology, etc.
Adjudication
The payment of a claim according to benefits.
Bill
Charges for a specific visit.
Claim
A detail-coded bill sent to the patient’s insurance company.
Copay
A fixed amount the insurance company requires the patient to pay — usually per visit.
Coinsurance
The percentage the insurance company requires the patient to pay after their deductible has been met.
Coordination of Benefits (COB)
Rules that determine which insurance is to be billed first for services when patient is covered by more than one carrier. State and Federal guidelines apply.
Deductible
An amount designated by the insurance company as the patient’s responsibility to pay.
Demographics
The patient’s address information.
DME
Durable Medical Equipment
Explanation of Benefits (EOB)
Itemized statement from your insurance company detailing which services are covered.
Facility
The hospital or clinic where services are performed.
Guarantor
The person or persons responsible for payment must be 18 years or older and legally competent.
Home Care
Medical services provided to a patient in their home.
Medicare Part A
Medicare hospital insurance covering care in the hospital, at any skilled nursing facility and from a home health agency.
Medicare Part B
Medicare supplementary medical insurance covering outpatient services from physicians, surgeons or any professional technicians.
Primary Insurance
Designation given to the insurer that has first priority for payment of a claim.
Provider/Physician
The professional doctor, therapists, nurse practitioner, etc., providing service to the patient.
Statement
A periodic summary of the accounts for the patient or family.