Claims

The portion of a mammography imaging claim applied toward a member's annual deductible before insurance coverage activates. Recorded in claims adjudication systems to reflect member cost-sharing obligations for breast screening or diagnostic imaging services.

The dollar amount reimbursed by a health plan for a mammography screening or diagnostic breast imaging service after adjudication. Used in claims financial reporting to track payer expenditures and support cost analysis for preventive imaging benefit categories.

Indicates whether reimbursement for a mammography breast imaging claim has been paid, is pending, or was denied by the health plan. Used in claims financial workflows to monitor payment resolution and support accounts receivable tracking for breast imaging services.

Documents the body systems reviewed during the clinical encounter associated with a mammography service, typically captured as part of the physician's review of systems in clinical documentation. Supports medical necessity determination and care quality reporting for breast imaging encounters.

The date on which a mammography screening or diagnostic breast imaging procedure was performed. Used in claims and clinical data systems to establish the encounter timeline, support HEDIS quality measure reporting, and verify preventive care compliance for health plan members.

The date a claim was submitted to a payer for durable medical equipment, supplies, or other medical materials provided to a patient. Used in claims processing to establish filing timelines and support billing compliance for supply-related reimbursement requests.

The current adjudication state of a claim submitted for durable medical equipment, medical supplies, or other patient care materials, such as pending, approved, or denied. Tracks payer processing decisions for supply-related claims within healthcare billing systems.

The dollar amount reimbursed by a health plan or payer for durable medical equipment, medical supplies, or patient care materials after claims adjudication. Used in financial reporting to track expenditures on supply-related claims and support cost analysis by material category.

Indicates whether reimbursement for a durable medical equipment or medical supply claim has been issued, remains pending, or was denied. Used in claims billing workflows to monitor payment resolution and manage accounts receivable for supply and equipment-related services.

The date a claim was submitted for a service involving a quantified clinical measurement, such as a lab result, vital sign, or diagnostic value. Used in claims data systems to track submission timelines for measurement-based encounters and ensure timely filing compliance.

The current adjudication state of a claim associated with a quantified clinical measurement or diagnostic value, such as pending, approved, or denied. Enables tracking of payer decisions for measurement-based clinical services within healthcare claims processing systems.

The dollar amount reimbursed by a payer for a claim tied to a quantified clinical measurement or diagnostic value after adjudication. Used in claims financial analysis to track reimbursement levels for measurement-based services and support cost benchmarking across clinical categories.

Indicates the current reimbursement processing state for a clinical measurement-based service or test, such as lab values or vital signs. Tracks whether payment is pending, approved, denied, or adjudicated within claims processing workflows tied to diagnostic or monitoring services.

Records the date a pharmacy or medical claim was submitted to a payer for a dispensed or administered medication. Used in pharmacy benefit management and medical claims processing to establish timelines for adjudication, coordination of benefits, and retrospective drug utilization review.

Captures the current adjudication state of a pharmacy or medical claim for a dispensed or administered drug, such as submitted, paid, denied, or reversed. Used in pharmacy benefit management systems to track claim lifecycle and support billing reconciliation and audit processes.

Records the dollar amount reimbursed by a payer for a dispensed or administered medication on a pharmacy or medical claim. Reflects the adjudicated payment after applying plan benefits, formulary rules, copays, and applicable rebates within pharmacy benefit management systems.

Indicates the current reimbursement processing state for a pharmacy or medical claim associated with a dispensed or administered drug. Tracks whether payment is pending, issued, denied, or reversed within pharmacy benefit management and claims adjudication workflows.

Records the dollar value of a financial correction or modification applied to a performance metric-based payment, such as a value-based care incentive or quality bonus. Used in population health and alternative payment model reporting to reconcile target versus actual reimbursement amounts.

Records the date a claim was submitted to a payer in association with a quantified performance or quality metric. Used in value-based care and alternative payment model tracking to establish submission timelines and align clinical performance data with reimbursement workflows.

Captures the current adjudication state of a claim linked to a quantified performance or quality metric, such as submitted, approved, denied, or under review. Used in value-based care programs and pay-for-performance models to monitor claim lifecycle and quality-based payment outcomes.