Reference
Revenue Cycle Glossary
Key terms and definitions for healthcare billing, denial management, and revenue cycle management.
C
A standardized code used by insurance payers to explain why a claim was adjusted, denied, or paid differently than billed.
A decision by an insurance payer to refuse payment for a submitted healthcare claim, typically communicated through an Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA).
The percentage of submitted claims that are accepted and processed by a payer on the first submission without requiring additional information, corrections, or resubmission.
The process of determining which insurance plan pays first when a patient is covered by two or more health insurance policies.
D
The systematic process of investigating, resolving, and preventing insurance claim denials to maximize revenue recovery for healthcare providers.
R
A supplementary code that provides additional context to a CARC code, offering more specific information about why a claim was adjusted.
The end-to-end financial process that healthcare organizations use to track patient revenue from initial appointment scheduling through final payment collection.
T
The deadline set by each insurance payer within which a healthcare provider must submit a claim for reimbursement, typically ranging from 90 days to one year from the date of service.