Understanding the Elements of Payments
This course identifies the components of participating and nonparticipating provider payment documents.
- Define non-participating and participating providers and when higher out-of-pocket amounts may occur.
- List terms which may be used on participating provider payment documents, such as Total Charges (Billed Amount), Contracted Charges (Allowed Amount), and Contractual Adjustment (Discount).
- Distinguish between various terms which refer to contract charges, such as Allowed Amount, Covered Amount, Charge Allowed, Allowable, Contract Allowable, Plan Allowed, Eligible Charges.≥
- Distinguish between various terms which refer to noncovered charges, such as Not Allowed, Ineligible, Excluded Charges, Pending, Not Payable, Service Not Covered, Rejection.’
- Distinguish between various terms which refer to contractual adjustment.
- Distinguish between various terms which refer to copay/deductible/coinsurance
- Distinguish between various terms which refer to payment.
- Assess payment accuracy.
