A formal request for payment submitted by a healthcare provider to an insurance company or payer for medical services rendered to a patient on an outpatient basis.
Healthcare services provided in an outpatient setting, allowing patients to receive medical care without the need for overnight hospitalization.
A set of medical codes used to describe specific procedures and services provided by healthcare professionals, crucial for billing and reimbursement in outpatient claims.
A coding system used to classify and report diseases, conditions, and related health problems, providing a standardized language for outpatient claim submissions.
A statement from the insurance company detailing the processing of an outpatient claim, outlining the services covered, amounts paid, and any patient responsibility.
The process of obtaining approval from an insurance company before providing certain outpatient medical services, ensuring coverage and reimbursement.
The amount a patient must pay out of pocket for covered healthcare services before the insurance plan starts contributing, impacting the calculation of outpatient claims.
A fixed amount that a patient pays at the time of receiving outpatient services, often required for each visit and varying based on the type of service.
The percentage of outpatient healthcare costs that a patient is responsible for after meeting the deductible, with the insurance plan covering the remaining percentage.
A network of healthcare providers with which an insurance plan has negotiated rates, affecting the cost-sharing components of outpatient claims.