Underlying condition or other condition that exists along with the condition for which the patient is receiving treatment. Used in diagnostic-related group (DRG) reimbursement. Sometimes referred to as comorbidity condition or concurrent condition.

Agency chartered under state laws that underwrites, administers, and sells many types of insurance plans (e.g., fire and marine, life, casualty, health, liability). For those it insures, it agrees to pay all legitimate claims that may arise under the policy in exchange for a monthly or annual premium. Also called agency or insurance agency, indirect payer, insurer , or payer . See also insurance carrier, fiscal agent , fiscal intermediary (FI) , or agency .

System of comparing costs of several types of life insurance policies such as the present value of premiums, cash values, and dividends. It is calculated by weighing each item each year by the probability that it will be paid. See also cost comparison methods.

In the Medicaid program, this term means that each state provides the same (comparable) benefits for those eligible except for those benefits in Medicaid waiver programs and benefits for children through Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) programs.

Medicare guideline stating that reasonable charges for medical services cannot be greater than similar services billed to non-Medicare patients covered by private insurance or managed care plans.

Patient’s situation that is documented as “either/or” in the medical record. Conditions include illness, disease, injury, pregnancy, bodily defect or abnormality, mental illness, alcoholism, or drug or chemical dependence.

Document that gives the annual comparison of a physician’s services and procedures to those of another doctor in the same specialty and geographical location.