Fee charged for the medical services rendered to a patient by a provider and submitted or transmitted by the provider on an insurance claim form. When the provider is billing, this total charge is inserted in Block 28 of the CMS-1500 insurance claim form. When the hospital is billing, this total charge is inserted in Field 47 of the UB-04 insurance claim form.
Tag: RAW
Amount of claim for Disputes
Disputes regarding Insurance claims relating to the amount payable under the Policy are settled through the process of arbitration provided in the Arbitration Act, 1996, as amended up-to-date. The arbitration condition in the Policy gives effect to this position.
Amount subject
The maximum amount that underwriters estimate can possibly be lost under the most unfavorable circumstances in any given loss, such as a fire or tornado. Contrast with Probable Maximum Loss.
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Maximum value of property which underwriters estimate can possibly be lost under the most unfavorable circumstances in any given event, such as a Fire. Refer “Loss, Maximum probable.”
Amount-in-controversy (AIC) requirements
In the Medicare program, the dollar amount of a medical service that has been denied and then appealed by the provider and patient to the insurance carrier for redetermination.
Amount, duration, and scope
Medicaid parameters defining a state’s benefits. Because each state has different Medicaid plans, these benefits will vary from state to state.
Amounts made good
The sums contributed as general average contributions to make good general average sacrifices. The allowances or amounts to be made good are formula-based to ensure equity in the adjustment. With expenditure, the amount made good is the expenditure itself.
Amounts paid in error
Payment of a claim in error by an insurer is recoverable if the mistake is of a fact, but not if the payment is by mistake of law. Failure to deduct excesses or apply average are mistakes of fact and can be recovered.
Analysis
Analytic system for the measurement of relative Fire hazard. A system for measuring the relative probability of Fire loss to property and of determining Fire Insurance premium rates.
Analysis of Risk
Process of locating loss exposures, measuring the amount of loss that exposures can produce, estimating the loss probability, and evaluating the exposures to determine actions necessary to meet the business (or family) risk management objective.
Anatomic modifiers
In Healthcare Common Procedure Coding System (HCPCS) Level II coding, two alphanumeric characters placed after the usual five-digit CPT procedure code number. These modifiers are used to identify specific anatomical parts of the body when the CPT procedure code does not include that information. HCPCS modifiers are accepted by insurance carriers nationally and are updated annually by the Centers for Medicare and Medicaid Services (CMS).