1. Health insurance payment system in which part of the premium is paid by the employer or local union and part by the employee through monthly or periodic payroll deductions. 2. Any pension or employee benefit plan in which participants make contributions to the plan from their own monies.

Unique multidigit number assigned to a submitted insurance claim by the insurance company and used to track claims in a carrier’s computer system.

Blue Cross and Blue Shield phrase that refers to a Blue plan that has sold a health insurance plan to a company with employees in other states and arranged for other Blue plans in the other locations to provide the same benefits. The control plan has the primary responsibility in administering the groups served by more than one Blue plan.

Officer in charge of the funds of an insurance company or an organization.

Disputed differences of opinion.

1. Rules or principles for determining a diagnostic code when using diagnostic code books such as each space, typefaces, indentations, punctuation marks, instructional notes, abbreviations, cross-reference notes, and specific usage of the words and, with, and due to. These rules assist in the selection of correct codes for the diagnoses encountered. Also called coding conventions. 2. Space-saving rule used in the “Index,” which is the last section of the annually published Current Procedural Terminology code book. For example:KneeIncision (of)In this example, the word in parentheses (of) does not appear in the Index, but it is inferred. As another example:PancreasAnesthesia (for procedures on)In this example, because there is no such entity as pancreas anesthesia, the words in parentheses are inferred (i.e., anesthesia for procedures on the pancreas).

Provision in a group insurance policy that allows the insured to convert to an individual insurance policy if and when the group coverage is ever terminated.

1. The dollars and cents amount that is established for one unit as applied to a service rendered. This unit is then used to convert various services/procedures into fee-schedule payment amounts by multiplying the relative value unit by the conversion factor. 2. National multiplier used to convert the relative value units for each procedure into dollar amounts. The CF is announced annually by the Centers for Medicare and Medicaid Services (CMS) for all services paid under the resource-based relative value scale (RBRVS) Medicare Fee Schedule. Sometimes called conversion number or national conversion factor.