Supplemental health benefit plan that pays for medical costs such as copayments and deductibles not covered by a primary benefit plan such as Medicare or TRICARE. Also called Medigap (MG) policy, gap fill, Medifill , and Medicare supplement policy .

In the Medicaid program, medical services not usually covered by managed care plans but covered either by referral or direct access to fee-for-service providers.

Order issued in writing by a court of law (e.g., subpoena).

Legal order by a court compelling a regulatory officer (insurance commissioner) to perform a specific act.

1. Assets or debts that have been determined to be uncollectable and are therefore adjusted off the accounting books as a loss. This does not represent a discount. 2. Difference between the total fee the provider billed for a medical service and the insurance company’s allowed fee for the service.

Misrepresentation or to withhold crucial facts in an adoption case (e.g., withholding medical or mental health history about a child when the parents expect to have a healthy child).

Termination of a life caused by a wrongful act, neglect, or fault (liability situation).X

American National Standards Institute (ANSI)- accredited group that defines electronic date inter change standards for many American industries including health care insurance. Most of the electronic transaction standards mandated or proposed under Health Insurance Portability and Accountability Act (HIPAA) are X12 standards. Also see Accredited Standards Committee X12 (ASC X12) .

X12 First Report of Injury, Illness or Incident transaction. This standard could eventually be included in the Health Insurance Portability and Accountability Act (HIPAA) mandate.

X12 Health Care Eligibility & Benefit Inquiry transaction. Version 4010 of this transaction has been included in the Health Insurance Portability and Accountability Act (HIPAA) mandates.