Medical service or other item listed as a line entry on an insurance claim form or other computer-generated document. Usual data are date of the service, procedural code, service fee amount, and so on.

Insurance carrier or fiscal intermediary’s refusal to pay one or more of the line items on an insurance claim due to a technical error or because of insurance policy benefit issues. Denied line items must be appealed by the provider except for emergency department visits in which the patient died during a procedure categorized as an inpatient procedure. In that situation, the claim is resubmitted as an inpatient claim.

Financial accounting procedure in which each payment is posted to the exact transaction for which the payment is received.

Insurance carrier or fiscal intermediary’s elimination of one or more of the line items on an insurance claim due to a technical error such as omission or erroneous information, or because it does not follow Medicare guidelines. In these situations the claim may be corrected and resubmitted by the provider, but they cannot be appealed.

1. Private indemnity insurance plan or managed care plan that is set up as a separate business unit within another larger organization (e.g., life insurance company, fidelity line, HMO, PPO). The LOB makes a distinction between the managed care plans from the free-standing company or one set up as a subsidiary. 2. Refers to a distinctive type of program within a health plan such as Medicaid. 3. Different types of health plans offered by a large insurance company or insurance broker as a product line.

For establishing medical necessity, software computer edits check procedure and HCPCS Level II codes that are connected (linked) to ICD-9-CM diagnostic codes submitted on insurance claims for payment. These must be supported by the documentation in the patient’s medical record.