Adjudication :
Processing a healthcare claim through a series of edits to determine proper payment.
Glossary
Healthcare and health insurance definitions.
A
Affordable Care Act (ACA) :
The healthcare reform law enacted in 2010. This term is short for PPACA, or the Patient Protection and Affordable Care Act, and is sometimes referred to as “Obamacare.”
Allowed amount :
Please see ACA Uniform Glossary
Alternative care :
(1.) Medical care received in lieu of inpatient hospitalization. Examples include outpatient surgery, home healthcare, and skilled nursing facility care. (2.) Nontraditional care delivered by providers such as midwives, acupuncturists, naturopaths, massage therapists, and chiropractors.
AMA :
American Medical Association
Ambulatory care :
Often called “outpatient care,” this is healthcare that takes place without being admitted to a hospital. For example, health services rendered in a physician’s office, a clinic, a hospital’s outpatient facility, or home setting.
Ancillary medical services :
Covered services that supplement the care furnished by providers. Examples of ancillary services include ambulance service, durable medical equipment, imaging services such as x-rays, laboratory services, prescription drugs, and physical or occupational therapy.
Appeal :
Please see ACA Uniform Glossary
ARRA :
The American Recovery and Reinvestment Act is also referred to as an economic stimulus bill. On February 17, 2009, President Obama signed the Act, which includes several provisions related to healthcare. In part, the Act creates new opportunities for individuals to qualify for continuation coverage provided by a group health plan. The Act also provides for a subsidy for that continuation coverage for some individuals and their family members.