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ABAllowed Benefit
Actual ChargeAmount a physician or other practitioner charges for a particular medical service or procedure. The actual charge may differ from the allowed charges under insurance programs.
AcupunctureA technique of oriental medicine performed only by licensed health care providers. Fine needles are inserted into the body at specific points to induce anesthesia, relieve pain or to treat other various disorders.
AdjudicationThe process used by health plans to determine the amount of payment for a claim.
AdmissionFormal acceptance as an inpatient by an institution, hospital or health care facility.
AHAAmerican Hospital Association
Allergy TreatmentPhysician directed medical treatment for allergies, which may include testing and the administration of serum through injections.
Allowed BenefitThe dollar amount allowed for services covered, regardless of the provider's actual charge. A provider who participates in a network cannot charge the member more than this amount for any covered service.
AMAAmerican Medical Association
Ambulatory BenefitsBenefits available for health care services received when a covered person is not confined to a hospital bed as an inpatient. Examples include outpatient care, emergency room care, home health care and pre-admission testing.
Ambulatory ServicesA wide range of health care services, including preventive care, acute care, surgery and outpatient care, in a medical care facility. Services do not require an overnight hospital stay.
Ambulatory SurgerySurgery which does not require an inpatient hospital admission for convalescence or recuperation. May also be referred to as one-day, same-day or outpatient surgery.
AMPAutomated Medical Policy
Ancillary ServicesHospital services other than bed, board and nursing care. Examples include drugs, dressings, operating room services, special diets, radiology, laboratory examinations, anesthesia and medications. Ancillary may include inpatient ancillary services, but also commonly includes services provided by ancillary providers in the home or outpatient setting (i.e., free-standing ambulatory surgical facility, radiology, laboratory and/or home health care).
AppealA process used by a patient or provider to request the health plan to reconsider a claim decision.
ASCAdministrative Service Contract or Ambulatory Surgical Center
ASCIIAdministrative Standard Code for Information Interchange
ASOAdministrative Services Only
ASPENAutomated Speech Exchange Network
AssignmentThe provider has agreed to accept Medicare's allowed amount as payment-in-full for the service rendered. The provider may not balance bill for these services. This amount may be reduced by specific coinsurance and deductible amounts to be paid by the member.
Attending PhysicianPhysician primarily responsible for the care of a patient in a health care setting (e.g. during hospitalization).
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