A clearer working vocabulary.
General introductions to administrative terms. Specific coding, payer, clinical and legal questions require qualified review.
- Revenue cycle management (RCM)
- The connected administrative work around intake, billing, payment follow-up and reporting. The exact scope varies by organization.
- Accounts receivable (A/R)
- Balances recorded as outstanding. A follow-up worklist identifies the reason, owner and next action for each item.
- Eligibility verification
- Checking coverage and benefit information for an administrative workflow. It does not guarantee claim payment.
- Prior authorization
- A payer-related approval workflow for applicable services. Requirements and decisions depend on the payer and the service.
- Credentialing & enrollment
- Processes for reviewing provider information and establishing payer participation. Submission, approval and effective dates are distinct checkpoints.
- ERA / EOB
- Remittance or benefit information used to review payments, adjustments and outstanding responsibility.
- Predetermination
- A dental-plan review process that may be relevant to proposed services. It is not the same as a payment guarantee.
- Dedicated Account Manager
- Your named operational point of contact for the agreed service relationship.