GLOSSARY
270/271 - An Inquiry to obtain current coverage information regarding a patient's health insurance company to see if a patient has valid health insurance coverage
276/277 - An inquiry to obtain information regarding an 837 submitted to a payer to get the status of a particular claim
835 - An explanation of benefits and an amount of payment paid to a physician in response to a claim
837 - A claim submitted to an insurance carrier for payment for a patient visit
ACH - Accept payments electronically from a patient's bank account
Adjudication - The determination of a member's payment, or financial responsibility, after a medical claim is applied to the member's insurance benefits
Consumer Driven Healthcare (CDH) - Health insurance plans that allow members to use personal Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs), or similar medical payment products to pay routine healthcare expenses directly, while a high-deductible health insurance policy protects them from catastrophic medical expenses
Claim Status - Validate and track claims through their entire life cycle
Claims - Provide immediate responses so you can detect claim errors, reduce the risk of compliance issues and ensure accurate reimbursement before claims are submitted to Payers
Coding Edits - Receive responses in standard X12 response format or human readable reports
eCheck - Is an electronic transfer of funds in which the money is taken from a bank account, typically a checking account. The account's routing number and account number are used to draw funds from the account. e-Checks can clear much faster than written checks.
Electronic Funds Transfer (EFT) - Refers to the computer-based systems used to perform financial transactions electronically
Electronic HealthCare Network Accreditation Commission (EHNAC) - Establishes criteria for measuring performance of clearinghouses and value-added networks. In Maryland and New Jersey, EHNAC accreditation is required of any entity processing healthcare transactions on behalf of healthcare organizations located in those states.
Eligibility - Everything that the payers store and HIPAA supports including year-to-date deductible and co-pay by facility
Eligibility Edits - In stream, real-time eligibility verification before claim is submitted. Receive responses in standard X12 response format or human readable reports.
Explanation of Benefits (EOB) - The statement that comes back, explaining each component of a submitted claim
Electronic Remittance Advice (ERA) - Informs service providers of the fiscal amount an insurance carrier will pay on a specific claim, including the amount to be paid for each particular service listed on the claim
Flexible Spending Account (FSA) - Allows an employee to set aside a portion of his or her earnings to pay for qualified expenses as established in the cafeteria plan, most commonly for medical expenses but often for dependent care or other expenses. Money deducted from an employee's pay into an FSA is not subject to payroll taxes, resulting in a substantial payroll tax savings.
Health Savings Account (HSA) - A tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a High Deductible Health Plan. The funds contributed to the account are not subject to income tax, but can only be used to pay for qualified medical expenses.
Healthcare Billing & Management Association (HBMA) - Dedicated to educating and supporting the needs of third-party billing organizations within the healthcare industry
Healthcare Clearinghouse - An entity that processes or facilitates the processing of information received from another entity in a non-standard format or containing non-standard data content into standard data elements or a standard transaction, or that receives a standard transaction from another entity and processes or facilitates the processing of that information into non-standard format or non-standard data content for a receiving entity
Health Insurance Portability and Accountability Act (HIPAA) - Improves efficiency and effectiveness of healthcare systems by standardizing the electronic exchange of administrative and financial data. Protects security and privacy of transmitted information.
Hospital Information System (HIS) - A comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. This encompasses paper-based information processing as well as data processing machines.
Health Reimbursement Accounts (HRA) - Partially self-funded means the employer pays a predetermined portion of medical claims up to a cap. After the cap is reached, the plan picks up the slack and pays an amount equal to its portion of the coinsurance. The patient continues to pay a percentage of claims until the out of pocket maximum, or "stop-loss amount" is reached. The plan then pays 100% of medical claims up until the end of the benefit period.
InstaAuth® - Patent pending transaction combines healthcare and payment transactions to automate the process of estimating the patient responsibility and authorizing funds at the point of service
InstaFund® - Patent pending transaction combines healthcare and payment transactions to automate the process of settling authorized funds from any account triggered by an adjudicated claim
Optical Character Recognition (OCR) - The mechanical or electronic translation of images of handwritten or typewritten text (usually captured by a scanner) into machine-editable text
Patient Estimator with Automated Payment - A seamless, automated solution that delivers an estimate of a patient's responsibility for co-pays, co-insurance and deductibles specific to the services you are providing and specific to your contract with the patient's health plan
Patient Payment Portal - A simple, convenient and secure way to pay online with credit, debit or the increasingly common varieties of healthcare accounts such as HSA, FSA or HRA
Payer - Organization that pays providers for healthcare services rendered in accordance with a contract between the health plan and member and the health plan and the provider
PCI Level One - InstaMed is certified as a Level One Service Provider with the Payment Card Industry (PCI) Data Security Standard, as well as the VISA Cardholder Information Security Program
Practice Management System (PMS) - A category of software that deals with the day-to-day operations of a medical practice. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payers, perform billing tasks, and generate reports.
Remittance - Automatically post 835 responses in a variety of formats, or use powerful query functionality to access or human readable formats for easy storage, retrieval and workflow integration
Remote Deposit - Patient and payer payments all from one system and one check reader
Return on Investment (ROI) - The ratio of money gained or lost on an investment relative to the amount of money invested
Swipe Device - A device that reads the magnetic strip on the back of cards
Third Party Administrator (TPA) - An entity that processes healthcare claims and performs related business functions to a health plan
Workgroup for Electronic Data Interchange (WEDI) - Is dedicated to improving healthcare through Electronic Commerce