| A | B |
|---|
| employer identification number (EIN) | identification number assigned by the IRS |
| adjudication | a claim is reviewed, and carrier makes payment decisions |
| Optical character recognition | claim is processed through a scanner |
| suspension file | series of files set up chronologically and labeled according to number of days since claim was submitted |
| insurance claims register or log | record claims information on a columnar form |
| explanation of benefits (EOB) | document sent by insurance carrier to provider and patient explaining how claim was adjudicated |
| downcoding | claims submitted with outdated, deleted, or nonexistent CPT codes |
| correct code initiative edits | result of the National Correct Coding Initiative |
| secondary claim | insurance company who pays after the primary carrier |
| coordination of benefits | determine which payer is primary and secondary when patient and spouse are covered under two separate employer group policies |
| birthday rule | the payer whose subscriber has earlier birthday in calendar year |
| Medicare Secondary Payer claims | claims submitted to another insurance company before submitted to Medicare |
| Real-time claims adjudication (RTCA) | electronic communication that allows instant adjudication of insurance claim |
| appeal | process of calling for a review of a decision made by a third-party carrier |
