Claims

Classification type for authorization within Claims processes in Healthcare implementations. Used for reporting, integrations, and downstream analytics.

The most recent date on which a prior authorization record was modified in the utilization management system. Captures any change to authorization status, approved services, units, or clinical notes, supporting audit trails and appeals processing in managed care workflows.

Indicates the clinical time sensitivity assigned to a prior authorization request, such as routine, urgent, or emergent. Drives processing timelines per regulatory requirements, including CMS and state mandates requiring expedited review for urgent cases in managed care and utilization management systems.

A sequential number identifying the iteration of a prior authorization record, incremented each time the authorization is amended or resubmitted. Enables tracking of changes across the authorization lifecycle in utilization management systems and supports audit, appeals, and concurrent review processes.

The five- or nine-digit postal code associated with the service location specified on a prior authorization request. Used to validate in-network facility alignment, apply geographic benefit rules, and route authorizations to the appropriate regional utilization management team for review and approval.

The date a claim was submitted or received for a service slot or open appointment period, used in scheduling and capacity management systems. Supports reconciliation of billed services against available provider time, tracking claim submission timeliness relative to the scheduled availability window.

The current adjudication state of a claim associated with an available service time slot, such as pending, approved, denied, or paid. Used in scheduling and billing reconciliation workflows to confirm whether services rendered during an open availability period have been successfully processed by the payer.

The dollar amount paid or expected for services rendered within a specific availability or scheduled time block. Used in practice management and billing systems to reconcile reimbursement against scheduled capacity, supporting revenue cycle analysis and identifying unpaid or underpaid availability-linked claims.

The current state of payment processing for a claim tied to a scheduled availability period, such as pending remittance, paid, denied, or withheld. Used in revenue cycle management to monitor cash flow and identify outstanding reimbursements associated with specific provider scheduling availability windows.

The dollar value applied to modify an outstanding patient or payer balance on a claim or account, reflecting contractual write-offs, corrections, or payment reversals. Used in revenue cycle and accounts receivable systems to reconcile billed charges against expected reimbursement and maintain accurate balance records.

The date a claim was submitted to a payer for an outstanding patient or account balance, typically following primary adjudication or coordination of benefits. Used in revenue cycle management to track billing timeliness, support collections workflows, and measure days in accounts receivable for unpaid balances.

The current adjudication state of a claim submitted for an outstanding balance, such as pending, denied, partially paid, or closed. Used in accounts receivable and revenue cycle systems to prioritize follow-up actions, manage secondary billing, and track resolution of remaining patient or payer financial obligations.

The portion of an outstanding balance attributable to the member's unmet annual deductible as determined during claims adjudication. Used in patient billing and revenue cycle systems to calculate member financial responsibility, generate accurate patient statements, and support collections for cost-sharing obligations under the member's health plan.

The dollar amount received or applied toward an outstanding account or claim balance from a payer, patient, or secondary insurer. Used in revenue cycle and accounts receivable systems to update remaining balances, trigger patient billing for residual amounts, and reconcile payments against original billed charges.

The current processing state of a payment applied to an outstanding claim or account balance, such as posted, pending, reversed, or written off. Used in revenue cycle management to track financial resolution of open balances, support accounts receivable aging analysis, and trigger appropriate follow-up or collections actions.

Documents the body systems reviewed during a clinical encounter associated with an outstanding patient balance, typically captured as part of the evaluation and management coding process. Used to validate medical necessity for billed services and support accurate E&M level assignment during coding review and accounts receivable audits.

The date on which clinical services were rendered that generated the outstanding patient or payer balance. Used in revenue cycle systems to calculate aging of unpaid balances, ensure timely filing compliance, and link financial obligations back to the original date of care for billing and collections workflows.

The date a claim was submitted for inpatient or facility bed-day charges associated with a patient admission. Used in hospital revenue cycle systems to track billing timeliness for accommodation charges, support payer follow-up workflows, and measure days between discharge and claim submission for inpatient stays.

The current adjudication state of a claim submitted for inpatient bed or accommodation charges, such as pending, approved, denied, or under review. Used in hospital revenue cycle management to track reimbursement progress for facility stays, prioritize follow-up on denied or suspended inpatient claims, and monitor payer response timelines.

The dollar amount paid by a payer for inpatient bed or accommodation charges billed on a facility claim. Used in hospital revenue cycle systems to reconcile per-diem or DRG-based reimbursement against billed accommodation charges, identify underpayments, and support contract performance analysis for inpatient services.