Federal legislation implemented in 1996 that attempts to eliminate unbundling or other inappropriate reporting of procedural codes for professional medical services rendered to patients. The quarterly updated code list identifies services considered either an integral part of a comprehensive code or mutually exclusive of it. Also known as National Correct Coding Initiative (NCCI).

Procedure/service code edits annually published to guide providers in appropriate choice of code(s) to submit for Medicare Part B insurance claims. There are two main types: comprehensive/component edits and mutually exclusive edits.

To fix an error by adding data to a patient’s existing chart or progress note by including the date, data, and signature of the individual making the correction.

Penal facility, jail, reformatory, detention center, work farm, halfway house, or residential community program center operated by, or under contract to, the United States, a state, a territory, a political subdivision of a state or territory, or an Indian tribe, for the confinement or rehabilitation of persons charged with or convicted of a criminal offense or other persons held in lawful custody (i.e., juvenile offenders, aliens awaiting deportation, persons committed to mental institutions through the criminal justice system, witnesses, or others awaiting charges or trial).

All documented communication that relates to the handling of an insurance claim (e.g., medical reports, test results, chart notes, electronic messages).

1. Required difference between a universal life insurance policy’s death benefit and the policy’s cash value. This difference is a specific percentage according to the insured’s age. If a policy’s cash value exceeds the required percentage of the death benefit (intrudes on the corridor), the policy is considered an investment contract instead of an insurance contract. Also called TEFRA corridor. 2. In reinsurance, an amount of insurance that is in excess of the ceding company’s retention limit but is less than the reinsurer’s minimum cession.

In a managed care plan, the amount that a member must pay before plan benefits are accessible.
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Deductible which applies between a layer of primary and a layer of excess Insurance, requiring the insured to retain a portion of each loss which exceeds the limit of the primary coverage before the excess coverage pays any remaining loss.

Elective operation of cutaneous or underlying tissues performed to improve appearance and correct a structural defect or to remove a scar, birthmark, or normal evidence of aging. Most health insurance plans do not pay for it unless disfigurement resulted from an accident or catastrophic event. Cosmetic surgery is differentiated from reconstructive surgery, which insurance programs feature as a benefit. Also called aesthetic surgery. See reconstructive surgery.