Term
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Description
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Account Number
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A number assigned to each bill by the provider of services; Columbia University Pathologists uses the term "Invoice#."
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Amount Paid
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The portion of the total bill that has been paid by the insurance company.
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Allowed Charges
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The amount the insurance company approved for processing.
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Capitation Accounts
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These are clients (HMOs, IPAs, physicians, etc.) who generally pay a fixed rate based on a number of members per month and/or volume of tests. Capitated clients usually provide services for HMOs.
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Claim Number
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The number assigned by an insurance company to a particular patient’s bill; this number is often provided on the insurance company's response to Columbia University Pathologists.
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Coinsurance
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The portion of the allowed charges (usually a certain percentage) that is the patient’s responsibility.
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Contract Charges
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The portion of the total bill that is NOT owed to Columbia University Pathologists (by the insurance company and/or the patient); this amount is based on the contractual agreement between the insurance company and Columbia University Pathologists.
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Coordination of Benefits
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Indicates the amount owed by another insurance company when the patient has additional insurance coverage.
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Copay
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The amount required to be paid by the patient.
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Date of Service
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The date on which the laboratory testing was performed.
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Deductible
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A specific annual dollar amount that must be paid by the patient before the patient’s insurance will begin reimbursing for covered services.
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Excess over UCR
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The portion of the total charges that is greater than the allowed charges; this amount is based on the contractual agreement between the insurance company and Columbia University Pathologists. "UCR" stands for usual, customary and reasonable.
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Explanation of Payment
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The section of an EOB that details how payments were made and explains any payment codes used.
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IPA
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Independent Practice Association
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Non-covered
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A specific service that is excluded from a contract and is considered non-payable by an insurance company. The patient may be responsible for this amount.
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Patient Information
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Various information including patient name, patient Id number, responsible party, subscriber, insured’s name, employee’s group number.
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Patient Responsibility
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Amount patient owes provider (Columbia University Pathologists). This includes "not covered" amounts, "deductible amounts," and any percentage of balance, if payment is less than 100%. Note: Although copays are not a part of this calculation, they are also the patient’s responsibility.
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Provider Information
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Payee (Columbia University Pathologists’s) name and mailing address. Additionally, may include account number on the claim, provider number and the name of the provider.
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Service Code
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A code representing the service provided.
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Submitted Charges
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The amount Columbia University Pathologists billed for service provided.
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Units
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The number of items included in this service.
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UCR
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Stands for usual, customary and reasonable and refers to fees for services. |
