Accounts receivable (AR) is the amount of money outstanding that is owed to the company as payment for services already rendered.

Approval for a service from the insurance company typically gained prior to the service being rendered.

The process of submitting claims to an insurance company. Claims include all pertinent information related to the service that would allow insurance companies to consider the service for payment.

The middleman between the provider and the insurance company that verifies claims for accuracy before forwarding it to the insurance company to be considered for payment.

Health insurance issued by a private company and not by the government, like in the case of Medicare and Medicaid. Also known as private insurance.

The process of determining how to cover healthcare cost used by insurance companies when a patient is covered by more than one insurance policy.

Current Procedural Terminology (CPT) codes are codes assigned to specific procedures or services rendered by healthcare providers.

To bill an insurance company as an in-network provider, providers must first go through a credentialing process specific to the insurance company.

Claims are denied by insurance companies for various reasons. To manage denials, one would have to follow up with the insurance company to inquire on the reason for the denial and find out how to correct the claim so that it can be reconsidered for payment.

Electronic Medical Record (EMR) software holds all the pertinent information related to patients and the services rendered to those patients by the provider.

In-network providers are credentialed with an insurance company and have a contract to provide service to their members at an agreed rate.

Modifiers are added to claims to provide additional information about the service rendered to make sure it is paid for properly by the insurance company.

Out-of-network providers do not have a contract with the insurance company and, therefore, services may not be covered by the insurance company or members may have to pay more for that service than they would with an in-network provider.

The portion of the cost of the service that the insurance company hold the patient responsible for covering, i.e. copay, coinsurance, deductible.

The payment made by the insurance company to the provider for services rendered.

Remittance advice is the statement that accompanies an insurance payment that explains why the insurance company paid the way they did. This can be received electronically, also known as an ERA, or as a paper remittance.

A Single Case Agreement (SCA) is an agreement made between an insurance company and an out-of-network provider that allows the provider to provide services to a member and receive in-network rates.