Match the following:

Question

A) deductible
B) electronic remittance advice (ERA)
C) conversion factor
D) coinsurance
E) relative value unit
F) reason code
G) adjudication
H) copayment
I) withhold
J) allowed charge

1) Code shown on an explanation of benefits (EOB) to explain the coverage determination or a denial
2) A set amount that the patient must pay at the time of service
3) The act of processing a claim that consists of edits, review, and determination.
4) Unit of measurement assigned to a service based on the skill and time required to perform it
5) A number used to multiply or divide a quantity when converting from one system of units to another
6) The maximum amount an insurance carrier will pay for a covered service
7) Percentage of the provider's payment held back to offset any additional costs under a capitation agreement
8) The amount that a policyholder must pay for covered services before insurance benefits begin to pay
9) Percentage of the cost of covered services that the policyholder must pay
10) Version of the EOB sent to the provider by the insurance carrier after the processing of electronic claims

Answer 1

1) F) reason code
2) H) copayment
3) G) adjudication
4) E) relative value unit
5) C) conversion factor
6) J) allowed charge
7) I) withhold
8) A) deductible
9) D) coinsurance
10) B) electronic remittance advice (ERA)