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CPT Current Procedural Terminology
A five-digit code used to descuibe what procedure were performed
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Customary Charge
One of the factors determining a physician's payment for a service under Medicare. Calculated as the physician's median charge for that service over a prior 12-month period
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Deductible
Amount a beneficiary is responsible for before the insurance company pays as stated in the insurance policy
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DEERS Defense Ecrollment Eligibility Reporting System
A support office for TRICARE enrollment or inquire about plan benefits
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DHHS Department of health and Human Services
The department of the U.S. Government that is responsible for setting and administering policy of health programs
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Dependents
The spouse and children of the insured as defined in the insurance contract
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Diagnosis
The process of determining by examination the mature and circumstances of a diseased condition
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DRG Diagnosis Related Group
A patient classification method that categorizes patients, for reimbursement purposes, who are medically related with respect to diagnosis and treatment and who are statistically similar in terms of their length of hospital stay
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Dirty Claim
A claim that is incorrect or is missing information when submitted
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Disability Income Insurance
A form of health insurance that provides periodic payments to repalce income when the insured is unable to work as a result of illness, injury or disease
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Downcode
When the procedure code billed is for a procedure that is less involved than the procedure actually documented in the chart
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EPSDT Early and Periodic Screening, Diagnosis and Treatment
Medicaid's comprehinsive and preventive child health program for individuals under the age of 21; includes periodic sereening, vision, dental, an hearing services
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ERA Electronic Remittance Advice
An electronic motification sent to the provider who accepts assignment. The ERA lists the dates of service, type of service, and charges filed on the claim
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EMC Electronic Media Claim
A insurance claim submitted to the carrier in a flat file format via electronic means, such as tape, diskette, direct wire, direct data entry, or telephone lines
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Enrollee
An individual who takes out and insurance policy in his or her name
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Established Patient
One who has received professional services from a physician or another physician of the same specialty who belongs to the same group practice within the past three years
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