Period during which a computer, communications line, or other device is malfunctioning or not operating correctly because of mechanical or electronic problems.

Reduce the value and procedure code of an insurance claim when the documentation supports a higher level of service billed by a provider.

1. Coding system used by the physician’s office does not match the coding system used by the insurance company receiving the claim. The insurance company computer system converts the procedure code submitted to the closest code in use, which is usually down one level from the submitted code, generating decreased payment. Sometimes downcoding may occur when the diagnosis code does not support the level of care. 2. Selecting procedure codes at a lower level than the medical service requires or documentation supports. Also called undercoding . Also see penalized claim.

To transmit or receive a data or graphic file from one computer to another.

To apply the correct commission scale to the insurance premiums received in order to compute the commissions due.