Pricer

1. Individual who reviews services, procedures, diagnoses, fee schedules, and other data and establishes the amount for a medical service or supply. Also called repricer. 2. Software package in an insurance claims processing system, specific to certain benefits, which analyzes specific data and determines the amount for a medical service or supply. Subsequently, other criteria are applied to establish the actual allowance or payment amount. It is most often used under prospective payment systems.

Prima Facie

Latin, “on first appearance.” A term frequently encountered in foreign trade. When a steamship company issued a clean bill of lading, it acknowledges that the goods were received “in apparent good order and condition” and this is said by the courts to constitute prima facie evidence of the conditions of the containers; that is, if nothing to the contrary appears, it must be inferred that the cargo was in good condition when received by the carrier.