Glossary · Foundations
Glossary · FoundationsEligibility Verification
The process of confirming, before a patient encounter, that the patient has active insurance coverage and that the planned service is a covered benefit. Conducted via electronic 270/271 transactions to the payer.
Definition
Eligibility Verification.
The process of confirming, before a patient encounter, that the patient has active insurance coverage and that the planned service is a covered benefit. Conducted via electronic 270/271 transactions to the payer.
Sources
Primary references for this entry.
- CAQH CORE Eligibility and Benefits operating rules.
- X12 270/271 transaction standards.
Related terms
Other terms in Foundations.
- Foundations
Charge Capture
The process of recording every billable service performed during a patient encounter, ensuring no charges are missed before claim submission.
Open entry - Foundations
Charge Description Master (CDM)
A hospital's complete list of billable items, services, and procedures with associated CPT/HCPCS codes, descriptions, and prices. Updated regularly as codes and prices change.
Open entry - Foundations
Prior Authorization
A payer requirement that a service be approved before it is rendered. Without an approved prior auth on file, the claim will deny on submission regardless of medical necessity.
Open entry
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