Tuesday, September 21, 2010

EOB terms


SERV DATE: Service date. Refers to the date services were rendered.

CPT CODE: Current Procedure Terminology. A 5 digit code, assigned for each procedure perform by physicians to communicate specific services rendered.

DESCRIPTION Describes the medical procedure performed at the time of visit.

QTY: Quantity. Refers to the number of times a particular service was performed.

BILLED Al’s/IT: Billed amount. The fee charged for a specific medical procedure.

MAX AMT: Maximum amount. Based upon the data gathered by the Health Insurance Association of America and/or other sources, the maximum amount fee is arrived at the compiling the prevailing fees in a geographical area and applying the reimbursement percentage purchased by a group/member. Provides are then reimbursed according to this percentile.

DEDUCTIBLE AMT: Refers to the amounts a Member must contribute on an annual basis before he/she is reimbursed for out-of-network services.

%: Refers to the percentage of the Maximum Amount fee for which the Member is responsible.
COPAY/CO-INS AMT: Copayment/coinsurance amount. The amount that the member is responsible for paying for the services rendered.

ADJ CODE: Adjustment code. A code that shows a correction, adjustment or denial has been made to a claim.

COB AMT: Coordination of Benefits. Refers to the amount covered by the Members alternative insurance carrier when that carrier is the “primary” insurance carrier.

PAYMENT AMT: The total amount that is reimbursed to the vendor.

PATIENT ACCT #: Patient account number. Refers to the provider’s account number or invoice number for the patient or claim.

DATE RECEIVED: The date received is the date that Oxford Health Plans received the claim; the date is reflected in the first four digits of a claim number. (e.g., 9049234568 - The first digit (9) indicated the year
1999 and the following three digits (049) indicated the day of the year the form was received (in
Julian date format). In this example, the claim was received on the 49th day of the year is
February 18, 1999.

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