| A | B |
|---|
| Third-Party Insurance | Insurance provided by an organization that pays all or part of a patient's healthcare expenses. |
| First Party | The patient in a third-party billing relationship. |
| Second Party | The healthcare provider in a third-party billing relationship. |
| Third Party | The insurance company or payer in a third-party billing relationship. |
| Payer | The organization or person responsible for paying all or part of a healthcare charge. |
| Extended Health Benefits | Insurance benefits that may cover services not fully covered by provincial health plans. |
| Employer Benefit Plan | A benefit plan provided through employment that may cover health-related expenses. |
| Disability Insurance | Insurance related to disability claims or documentation supporting time away from employment. |
| Travel Insurance | Insurance that may cover health expenses related to travel. |
| Automobile Insurance | Insurance that may cover healthcare services related to motor vehicle accidents. |
| Private Health Plan | A privately purchased or employer-provided plan that may cover services not paid by public plans. |
| Insurance Billing | The process of submitting claims to an insurer for services covered by a patient's plan. |
| Patient Billing | Charging patients for services not covered by provincial health insurance, private insurance, or another third-party payer. |
| Patient Direct Billing | Billing the patient directly for uninsured or uncovered services. |
| Medico-Legal Billing | Fees charged for medical services, forms, reports, or opinions related to legal matters rather than direct insured patient care. |
| Accurate Claim Submission | Submitting complete and correct billing information to the correct payer. |
| Payment Delay | A delay in receiving payment, often caused by missing, incorrect, or incomplete billing information. |
| Claim Rejection | A claim not accepted or processed due to an error or missing information. |
| MOA Role in Third-Party Billing | Collecting insurance information, verifying coverage, preparing claims, tracking payments, following up, and explaining billing procedures. |
| Insurance Information Collection | Gathering accurate insurance details before billing or submitting claims. |
| Policy Number | The number that identifies a patient's insurance policy. |
| Group Number | A number that identifies the group plan, often connected to an employer benefit plan. |
| Policyholder | The person who holds the insurance policy. |
| Policyholder Relationship | The patient's relationship to the policyholder, such as self, spouse, child, or dependent. |
| Coverage Dates | The dates during which an insurance policy or benefit is active. |
| Authorization Number | A number showing that a service or claim has been authorized, when required. |
| Claim Number | A number used by an insurer or payer to identify a specific claim. |
| Coverage Verification | Confirming that the patient's insurance plan is active and applies to the service. |
| Active Coverage | Insurance coverage that is currently valid and available. |
| Covered Service | A service eligible for payment under the patient's insurance plan. |
| Coverage Limit | A maximum amount, frequency, or condition that limits insurance payment. |
| Deductible | The amount a patient may need to pay before insurance coverage begins. |
| Co-Payment | The portion of the cost the patient pays at the time of service or after insurance is applied. |
| Pre-Authorization | Approval from an insurer before a service is provided or billed. |
| Direct Billing | A billing process where the clinic submits the claim directly to the insurer and the patient pays any remaining balance. |
| Reimbursement Billing | A billing process where the patient pays the clinic first and then submits the claim to the insurer for repayment. |
| Receipt | Proof of payment provided to the patient, often needed for reimbursement billing. |
| Completed Claim Form | A form prepared so the patient or office can submit a claim to the insurer. |
| Insurance Billing Workflow | Collect information, verify coverage, provide service, complete claim, submit claim, record payment, bill balance, and follow up. |
| Insurer Payment | The amount paid by the insurance company toward the service. |
| Remaining Balance | The amount still owed by the patient after insurance or third-party payment is applied. |
| Unpaid Claim | A claim that has not yet been paid by the insurer or payer. |
| Denied Claim | A claim refused by the insurer because requirements were not met or the service was not covered. |
| Common Insurance Claim Denials | Missing information, incorrect policy number, expired coverage, missing signatures, non-covered service, duplicate claim, incomplete documentation, wrong insurer, or service date errors. |
| Motor Vehicle Accident Insurance | A common type of third-party billing in medical offices that follows provincial procedures and office policy. |
| Patient-Billed Service | A service billed directly to the patient because it is not covered by a public plan, private insurance, or another payer. |
| Uninsured Service | A service not covered by the provincial health plan. |
| Missed Appointment Fee | A fee charged when a patient misses an appointment, according to clinic policy. |
| Medical Report or Letter | A document that may be billed directly to the patient or requesting party if not insured. |
| Insurance Form | A form completed for insurance purposes that may be patient-billed or third-party billed. |
| Driver's Medical Examination | A medical examination often billed directly to the patient when not insured. |
| Cosmetic Procedure | A procedure for cosmetic purposes that may not be covered by provincial health insurance. |
| Travel-Related Service | A service or vaccine related to travel that may not be publicly covered. |
| Record Transfer Fee | A fee for copying or transferring records, where permitted. |
| Third-Party Examination | An examination requested for a non-medical or third-party purpose. |
| Patient Statement | A document showing what the patient owes and why. |
| Patient Invoice | A bill that includes patient name, service date, service description, charge, payments, balance, due date, instructions, and clinic contact information. |
| Due Date | The date by which payment is expected. |
| Payment Instructions | Directions explaining how the patient can pay the balance. |
| Collecting Patient Payments | Accepting and recording payment for services according to office procedures. |
| Payment Method | The way payment is made, such as cash, debit, credit card, cheque, electronic transfer, or online payment. |
| Payment Reconciliation | Balancing and comparing payment records to ensure payments were recorded correctly. |
| Payment Receipt | A record given to the patient showing payment was received. |
| Outstanding Account | An unpaid patient balance that must be followed up according to office policy. |
| Reminder Notice | A follow-up notice sent to remind a patient of an unpaid balance. |
| Telephone Contact | A follow-up call about an unpaid account, handled professionally and confidentially. |
| Payment Arrangement | An agreement about how a patient will pay an outstanding balance, if permitted by office policy. |
| Collection Procedure | A formal process used to pursue unpaid accounts when necessary. |
| Medico-Legal Service | A service, form, report, or opinion related to legal matters rather than direct insured patient care. |
| Requesting Party | The person or organization asking for the medico-legal service or document. |
| Patient Consent | Patient authorization that may be required before completing or releasing medico-legal information. |
| Authorization | Proper permission required before releasing patient information or sending medico-legal documents. |
| Release of Information | The process of releasing patient information only with proper authorization and according to policy. |
| Turnaround Time | The expected time needed to complete a form, report, or medico-legal document. |
| Uninsured or Direct Billing Guide | A provincial guide that may suggest fees for uninsured or patient-billed services. |
| Privacy in Insurance Billing | Protecting insurance, financial, and medical information through secure records, identity verification, privacy legislation, and limited sharing. |
| Fraud Prevention | Preventing false claims, altered documents, billing for services not provided, and duplicate submissions. |
| False Claim | A claim submitted with information that is not true or accurate. |
| Altered Document | A document changed improperly or dishonestly. |
