Twelve-month period used by employers for administration of health benefits. Most employers’ benefit year is from January through December. However, a benefit year does not always coincide with a group’s fiscal year. See benefit period .

Scope, terms, and conditions of coverage including any limitations associated with the plan provision of the service. Also called benefits plan and benefit package .

Medi-Cal identification card.

Federal legislation that made the Medicare appeals process easier to negotiate with clearly defined levels that address reasons for rejection based on complexity of the situation. Terminology for these levels is called “redetermination” or “reconsideration” and is no longer known as an appeal.

A surgical procedure performed on both sides of the body or organ.

Situation when a surgical procedure is performed on both sides of the body or organ. A five-digit CPT code number is used with an attached modifier -50 to list the procedure. If listing more than one modifier, place modifiers affecting reimbursement first, in descending order, followed by status modifiers.

To assign a fee for medical services and supplies provided by a provider that were rendered to the patient and to present an itemized statement of the charges.

1. Day of the month on which specific groups (Medicare, Medicaid, managed care, commercial payers) are scheduled to be billed. There are 30 bill-cycle days per month including weekends and holidays. 2. Day of the month on which specific accounts by alphabet, account number, insurance type, or date of first service are scheduled to be billed. Also see cycle billing .

Rate of regularity that a subscriber or group is billed by the insurance company for premiums due. This may be monthly, quarterly, or annually.