Written request made to an insurance company to locate the status of an insurance claim (i.e., claim in review, claim never received, clarification about something related to the member’s health plan) or general information such as deductible or entitlement. Also called inquiry . An inquiry is not a complaint.

Review system in hospital facilities used by The Joint Commission surveyors in which they randomly select patients, obtain their medical records, and then trace the path of the patients by visiting the units, sites, or departments in the exact sequence, when possible, that the patients experienced. The surveyor talks to the direct caregivers who provided care and treatment to the patient. The Joint Commission assesses care and compliance with relevant standards related to operational systems and processes based on actual experience of the patients.

Electronic reminder method used to track pending or resubmitted insurance claims and to telephone or send inquiries about nonpayment. Also called a suspense, follow-up file , or tickler file . Also see tickler file .

1. External entity with whom business is conducted (i.e., customer). This relationship can be formalized via a trading partner agreement. A trading partner of an entity for some purposes; may be a business associate of that same entity for other purposes. 2. Company that agrees to exchange information electronically with another company.

1. Any contract (manual, bulletin, or memorandum) between the provider and the claim transmission receiver that details the electronic data interchange requirements between the parties. 2. Under the Health Insurance Portability and Accountability Act (HIPAA), a TPA may not include any agreement to use the codes, segments, or transactions published in an implementation guide in a manner different from that prescribed in the applicable guide.

Under the Health Insurance Portability and Accountability Act (HIPAA), transmission or exchange of information between two parties to carry out financial or administrative activities related to health care.

Electronic method established under the Health Insurance Portability and Accountability Act (HIPAA) for accepting and tracking change requests for any of the adopted HIPAA transaction standards via a single website.

1. Under the Health Insurance Portability and Accountability Act (HIPAA), a complete batch of claims that includes the header, trailer, and claim data. 2. Series of blocks that compose a business transaction (e.g., patient admission form).