Insurance claim that cannot be processed due to the type of software program used to transmit the claim; it may be incompatible with the receiving system.

Under the TRICARE program, medical care given in a military treatment facility. Also called in-house care .

System in which members of an insurance plan transact claims straight to the payer instead of submitting claims through an employer.

Health plan that contracts straight to private practice physicians or provider groups in a locale rather than through an intermediary or managed care company (e.g., open panel health maintenance organization [HMO]).

Dollar value that is related to a given object or specific service (e.g., medical equipment or medical supplies).

Under the Health Insurance Portability and Accountability Act (HIPAA), this is the access of data directly into the computer through machine-readable source documents or through the use of online terminals that is immediately transmitted into a health plan’s computer.

Monies electronically sent to an account in a financial institution (i.e., bank, trust company, savings and loan association, brokerage agency, or credit union).