Insurance claim that has been canceled, deleted, or voided by a Medicare fiscal intermediary for the following reasons: CMS-1500 (08-05) or current CMS-1450 is not used, itemized charges are not provided, more than six line items are submitted on the CMS-1500 (08-05) claim form, patient’s address is missing, internal clerical error was made, Certificate of Medical Necessity (CMN) was not with the Part B claim or was incomplete or invalid, and name of the store is not on the receipt that includes the price of the item.

Dollar amount that is overdue from a patient who has received medical services.

Insurance claim submitted to an insurance company, for which payment is overdue. See pending claim .

Dollar amount for which reimbursement is overdue.

Dollar amount due to the insurance company for an insurance policy premium that has not been paid by the end of the grace period. This sum may be due monthly, quarterly, or annually.

Amount of services and procedures required from a health care system by a specific population of patients.

Invoices sent to the Medicare administrative contractor for medical review and payment determination at the request of the beneficiary because the patient disputes the provider’s opinion that the bill will not be paid by Medicare.

This phrase is used in managed care and is a technique or process used to match patient needs with a quality, cost-efficient atmosphere and at the same time influencing self-care to members, which lowers their needs for services and results in lower costs of care.

Phrase that refers to obstacles in getting medical care by patients who do not have the income to pay for health care services or obtain medical insurance.