Insurance Eligibility and Other Payer Requirements

Comprehensive vocabulary flashcards covering patient registration, insurance types, and financial responsibilities based on the CPT study guide.

Preregistration

The foundation of a claim that begins the patient account process and can occur during the first phone call or when the patient arrives at the office.

Patient demographic information

Details collected for the patient account including first and last name, sex, gender, date of birth, mailing address, contact info, emergency contact, and reason for visit.

Assignment of benefits

A form or notification signed by the patient to bill and receive insurance payments directly.

Third-party payer

Entities that provide coverage for medical expenses and loss to the policyholder, available through employers, commercial or private organizations, and government programs.

Guarantor

The individual who is responsible for paying any patient responsibility after the insurance has processed a claim.

Policyholder

The individual who signs a contact with a health insurance company.

Electronic medical record (EMR)

A patient’s medical record in a digital format that resides within a health care organization.

Electronic health record (EHR)

A collective of medical records that is used and shared by more than one organization or provider.

Workers' Compensation (WC)

Insurance providing benefits and wage replacements to employees needing medical care due to a work-related injury or accident.

30 days

The timeframe required by the U.S. Department of Labor for an employee to report a work-related injury.

Out-of-pocket expenses

Medical costs that are the financial responsibility of the guarantor, not the health plan.

Auto insurance

A contractual agreement between the policyholder and insurance company that protects the driver and passengers and pays for related medical and wage replacement expenses.

National Association of Insurance Commissioners (NAIC)

The organization that identifies the coverage requirements for auto insurance.

Med pay (medical payments coverage)

A feature of some auto policies that assists with medical expenses for the policyholder or passengers regardless of who caused the accident.

Premium

The amount a patient pays each month to receive benefits.

Deductible

The annual amount the patient must pay before the insurance will begin to pay for covered benefits.

Copayment (copay)

A flat, fixed amount that a patient pays for specific services, such as office or emergency department encounters.

Homeowners insurance

Coverage for events occurring to the home/property as well as liability for injuries to the homeowner or others while on the property.