Blue Cross and Blue Shield phrase that means the formal notice sent by a host plan from the home plan after the home plan has received the admission wire and verified membership information. This approval is given for a specific number of days and insurance contract benefits. See also admission wire.
Tag: MEDICAL
Approved amount
See: approved charge.
Approved charge
1. Maximum dollar value the commercial private insurance company or managed care contract assigns to each procedure or service on which payment is based. Typically, a percent (e.g., 80%) of the allowed amount is paid by the insurance carrier. 2. Allowed amount based on the Medicare fee schedule or its transition rules, which may or may not be the same as the actual amount billed. The patient may or may not be responsible for the difference. Nonparticipating physician charges are subject to the limiting charge. 3. Also called the allowed amount or approved amount. See also Medicare-approved amount, maximum allowable, and maximum allowable charge (MAC).
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Amounts paid under health insurance as the maximum fee for a covered service.
Approved health care facility
1. Medical facility authorized to provide medical services and specific health care services stated in managed care contracts. 2. Hospital authorized to treat and admit beneficiaries of the Medicare program. Also known as approved health care hospital .
Approved health care hospital
See: approved health care facility.
Approved health care program
Medical program certified or endorsed to provide services to members of a managed care plan or beneficiaries of a federal program (e.g., Medicare, TRICARE).
Approved services
See: benefit package.
AQ
Modifier used by physicians who provide medical services in health professional shortage areas (HPSAs) that became effective January 1, 2006. Previously, two modifiers (QB and QU) distinguished between physicians providing HPSA services in rural areas and those providing HPSA services in urban areas. These are no longer used.
AR
1. HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating a physician scarcity area. Use of this modifier affects Medicare payment. 2. Abbreviation for accounts receivable. See accounts receivable (AR).
Arbitration
Proceeding for settling a dispute in which disputes are given to a third party or panel of experts to hear two sides of the story and who has power to make a legal binding decision for both parties on the case.
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US: Arbitration: A form of alternative dispute resolution where an unbiased person or panel renders an opinion as to responsibility for or extent of a loss.
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UK: An alternative to going to court for the settlement of a dispute. An independent arbitrator hears the case and makes an award in accordance with the Arbitration Act 1996. See ALTERNATIVE DISPUTE RESOLUTION.
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An alternative to litigation by submitting a dispute to the judgment of a specified number of disinterested persons called “arbitrators,” whose decision called an “award” is binding on the parties. (I)Form of Alternative Dispute Resolution (II) Alternative to court room litigation (III) Parties submit their disputes to a NEUTRAL third party called the Arbitrator (s) or Arbiter (s) for resolution (IV) Binding dispute resolution, equivalent to litigation in the courts.
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UK: an alternative to litigation for the settlement of insurance disputes; contracts often specify the place of arbitration in the event of a dispute.