Description that names several people as a group instead of naming each person individually (e.g., children of the insured).

Method that provides the basis for payment that identifies medical services that will be charged fees separately (e.g., diagnosis-related groups [DRGs] patient classification system used for inpatient hospital prospective payment system, Healthcare Common Procedure Coding System [HCPCS] used in the Medicare fee schedule for physicians).

Type of hospital invoice (patient’s financial accounting statement) assessed by someone auditing a hospital bill that has no errors. Also see under bill and over bill.

Completed insurance claim form submitted within the program time limit that contains all the necessary information without deficiencies so that it can be processed and paid promptly; a claim that passes all electronic claim edits and claim audits; or a claim that is subject to medical review but is submitted with complete data attached or forwarded simultaneously with electronic media claim records.

Lump-sum type of life insurance death benefit to assist in paying the insured’s outstanding debts, funeral expenses, and related expenses—in other words, “cash” to clean up expenses.

Independent organization that receives electronically transmitted insurance claims from the physician’s office, performs software edits, routes, and transmits the claims to various insurance carriers. Also see health care clearinghouse.

Minor omission or error in form or content on Medicare Part A or Part B claims, such as missing data items (provider number or date of service). Omissions do not include failure to bill for certain items or services or third-party payer errors.

Insurance policy condition that if a person is eligible and submits a written request for coverage, he or she will not be denied coverage if the policyholder fails to give proper notice to the insurance company because of a clerical error.

1. Person who is the recipient of a professional service. 2. Recipient of health care. 3. Patient. 4. System (software running on a piece of hardware) that initiates the process or requests services in a client/server computing arrangement.