Glossary of Terms
835 File
- Also referred to as: Electronic Remittance Advice (ERA)
- The 835 is the electronic transaction that provides Claim Payment information which is used to auto-post Claim Payments.
- Allowed Fee
- This is pulled from the uploaded Allowed Fee Schedule and indicates the Payer's expected contractual amount.
- ALWD
- This is the posted allowed amount that was provided on the EOB/ERA from the Payer for an Encounter.
AM
- Account Manager
ANSI
- National format standard for transmitting electronic information.
Applied Date
- This is the date the Applied button was used on the ERA.
- This date may be different than the Post Date since the Post Date is driven by the Date used in the Reference Batch.
Beta Feature
- The early use of a new feature that allows Users the chance to take advantage of the functionality and provide feedback before the feature's general release.
Bill Date
- The most recent date that the claim was billed to the Responsible Party.
BWC
Bureau of Workers' Compensation (or WC)
CM
- Crossover Mapping on an ERA.
- Contract Management: Category option on the CARC Denial Rules
Days in A/R
- Total A/R divided by the average billed amount per day over a given time period.
- It is the number of days the average claim will remain outstanding before payment is made.
DB
- Database
- On the Receipt, the Disbursed field can be used to flag items that do not belong in the System, such as, Old System Payments.
DOS
- Date of Service
EDI
- Electronic Data Interchange.
- The method in which Claims, Eligibility, and Remittances are processed electronically.
Modify Icon
- The Pen and Paper Modify Icon appears throughout the System and is used to modify previous entries.
- This icon will be referred to as the Modify icon in the documentation.
EFT
- Electronic Funds Transfer
- The Payer deposits the Payment directly into the bank instead of sending a paper check.
- The Practice is responsible for completing the setup with each Payer.
- We do not manage the setup for EFTs.
Encounter
- A Charge that can contain multiple Dates of Service.
- The System is an Encounter-based accounting system, which means it looks to the charge to drive a majority of the reporting.
EOB
- Explanation of Benefits: This is a statement received from the Insurance Company that summarizes the cost of health care services that were received.
- Shows how much the Provider is charging the Insurance Company, how much the Insurance is paying, and the Patient's responsibility.
- It is not a bill.
ERA
- Electronic Remittance Advice
- An electronic Explanation of Benefits (this is not the same as an EFT).
- Some payers require enrollment to receive electronic EOBs.
- ERAs are used to auto apply transactions based on the file that the Payer provides us with.
- Money that has been entered into the system on a Receipt but has not yet been applied to a service/Encounter.
- It is used as a temporary holding place until the Payment is posted in full.
Etactics
- Clearinghouse
- Used to send, receive and process electronic Claims, Eligibility and Remittances. Enrollments for Claims, Eligibility and Remittances are handled by Etactics.
Etactics Output Solutions
- Etactics Output Solutions is a Partner that is used for sending Statements and Invoices.
Fee Schedules
- Charge Each DB should have one default charge fee schedule. These are the fees per CPT® we send on the encounter or charge
- Allowed: It is recommended each DB has at least the Medicare allowed fee schedule - this can be used to be sure you are being paid according to the contract you have with the payer
Go Cuts
- Keyboard shortcuts to the various areas of the System.
Go-Live
- Date that the Practice will begin billing Claims and partner Invoicing for the Practice’s services will begin.
HCFA
- Paper Claim Form
Show Me How
- Help documents, walk throughs, and videos embedded in the System.
IM
Implementation Manager (Trainer)
Implementation
- The process in which a Partner or a Practice is involved in during the initial setup.
Libraries
- Used as the basic building block for Claims, Statements, and Calendar setup.
Loaded Date
- The date the ERA was loaded into the PM System.
- This date may be different from the Received Date.
OS
- Output Solutions (Statement Department)
Parse
- To convert the imported data file into System mapped fields
Payer
- Insurance Company, Attorney, Collection Agency or Third Party responsible for processing and paying Claims.
Payer ID
- Most Insurance companies are able to process Claims, Eligibility and Remittances electronically.
- The Payers have a correlating Payer ID which serves as an electronic address.
PM
- Practice Management
Pop-up
- A smaller screen within a larger screen.
- These may be validation errors or warnings or a screen for entering additional information.
POPS (PatientOps)
- Patient Online Payments & Scheduling (Premium add-on).
- Online Payments are live and Scheduling is coming soon.
POS
- (Place of Service) Place where the service is performed.
- Selecting Yes for the POS Payment field allows you to track Payments that were made in the office.
- When adding the Receipt from the Calendar, it automatically defaults to Yes, but has to be chosen when adding a Patient Payment from the other places in the System.
- Report on POS Payments using these reports Custom Receipt Query, Payments and Adjustments Report, and Receipt Management Report.
Post Date
- The Post Date is determined by the Date set in the Reference Batch.
- It can be used to manipulate Post Dates at month end.
Receipt
- The Receipt holds the details of the money received, who the Payer is, how much was deposited in the bank.
Received Date
- The Received Date is entered on the Receipt or the date that auto-populates on the ERA Receipt.
- This is the date that the Payment was received.
Responsibility Date
- The date that the party became responsible for the Balance.
- Self-Pay: The date the Charge was posted.
- Not Self-Pay: The date the Balance was transferred to the Patient.
RTCS
- Electronic Method of getting an immediate Claim Status update from the Payer.
RVU (Relative Value Unit)
- RVUs define the value of a service or procedure relative to all services and procedures.
Site Admin
- Each practice should have 1-2 PM Super-Users that will have all permissions and security rights in order to manage the database properly and its users.
Statement Department
- Etactics Output Solutions is a Partner that is used for sending Statements and Invoices.
TPA
- A Third Party Administrator is the entity responsible for the Processing and Payment of Claims for an Employer.
WC
Workers' Compensation
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