A participating life insurance policy is a policy that receives dividend payments from the life insurance company. Thyroid disorders Due to the severity of the breach, the organization terminates the nurse.Based on this incident's severity, your organization has established a task force with two main goals: Competency 2: Implement evidence-based strategies to effectively manage protected health information. Prevent confidentiality, security, and privacy breaches. Consult the BSN Program Library Research Guide for help in identifying scholarly and/or authoritative sources. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use The will support your success with the assessment by creating the opportunity for you to test your knowledge of potential privacy, security, and confidentiality violations of protected health information. Except as otherwise provided in this section, the non-contracting Allowable Amount is developed from base Medicare Participating reimbursements adjusted by a predetermined factor established by BCBSTX. & \textbf{Quantity} & \textbf{Unit Cost}\\ MAXIMUM ALLOWABLE PAYMENT SYSTEM. The details of gap plans change each _____, although they must cover certain basic _____. Senior Federal Law Enforcement Official D. The Strategic Information and Operations Center, For non-Stafford Act. www.tricare.milis an official website of theDefense Health Agency (DHA), a component of theMilitary Health System. Any change to the Medicare reimbursement amount will be implemented by BCBSTX within ninety (90) days after the effective date that such change is implemented by the Centers for Medicaid and Medicare Services, or its successor. If Family coverage is elected, Deductible means the dollar amount of Eligible Expenses that must be incurred by the family before benefits under the Plan will be available. The board of directors is elected by the policyholders; however, officers oversee the company's operations. What is the difference between excluded services and services that are not responsible and necessary? Conduct independent research on the topic you have selected in addition to reviewing the suggested resources for this assessment. In your post, evaluate the legal and ethical practices to prevent fraud and abuse. Some documents are presented in Portable Document Format (PDF). By issuing participating policies that pay policy dividends, mutual insurers allow their policyowners to share in any company earnings. Nurses typically receive annual training on protecting patient information in their everyday practice. Nurses typically receive annual training on protecting patient information in their everyday practice. A stock insurer is referred to as a nonparticipating company because policyholders do not participate in dividends resulting from stock ownership. The patient __________ expected to pay the difference between the insurance payment and the provider's fee. The Medicare Physician Fee Schedule (MPFS) uses a resource-based relative value system (RBRVS) that assigns a relative value to current procedural terminology (CPT) codes that are developed and copyrighted by the American Medical Association (AMA) with input from representatives of health care professional associations and societies, including ASHA. Your organization requires employees to immediately report such breaches to the privacy officer to ensure the post is removed immediately and that the nurse responsible receives appropriate corrective action.You follow appropriate organizational protocols and report the breach to the privacy officer. One reason may be the fee offered by your carrier is less than what they are willing or able to accept. In this scenario, Medicare would pay you $80, and the patient would pay you $20. Consult the BSN Program Library Research Guide for help in identifying scholarly and/or authoritative sources. You can also check by using Medicares Physician Compare tool. For premium-based plans, your monthly premiums dont apply toward your catastrophic cap. If you use a non-participating provider, you will have to pay all of that additional charge up to 15%. Prevent confidentiality, security, and privacy breaches. 2014-06-10 21:42:59. Our tutors are highly qualified and vetted. Download a PDF Reader or learn more about PDFs. 4. How long is the grace period for health insurance policies with monthly due premiums? A payment system that determines the allowable amount. Questions are posted anonymously and can be made 100% private. These infographics serve as examples of how to succinctly summarize evidence-based information. Once you've chosen the subject, research and work up a common chief complaint from that system that you haven't learned al NUR 370 Denver School of Nursing Week 6 The Neighborhood Article Discussion. $76 x 80% = $60.80 This is the allowed charge. For example, a Texas nurse was recently terminated for posting patient vaccination information on Facebook. Non-pars are reimbursed 5% less than the Medicare Physician Fee Schedule (MPFS) amount. Under the Medicare Part B traditional fee-for-service plan, Medicare pays ______ percent of the allowed charges. \text{Operating expenses}&\underline{420,392}&\underline{396,307}\\ Provide details on what you need help with along with a budget and time limit. i.e. PLEASE USE THE CHARACTERS FROM THE DISCUSSION FOR NUR445 WEEK 6Step 1 Access The Neighborhood and read the neighborhood ne Research several hospitals of your choice and identify how many Board members are on the Board and their length of appoi University of North Texas Strategies for Obtaining a Complete Health History Discussion. By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria: non-participating provider "Non-Par" A provider that has NO contract and can bill the patient over and above the amount of the allowable fee Sets found in the same folder 2 terms You do not have JavaScript Enabled on this browser. patient's name & mailing address(info) The limiting charge is 115% of the reduced MPFS amount. For example: As a non-participating provider, Dr. Carter doesn't agree to an assignment of benefits. Can I stay on my parents insurance if I file taxes independently? Identify evidence-based approaches to mitigate risks to patients and health care staff related to sensitive electronic health information. When you meet your individual deductible, TRICARE cost-sharing will begin. Non-Participating Provider A physician, hospital, or other healthcare entity that does not have a participating agreement with an insurance plan's network. Prepare a 2-page interprofessional staff update on HIPAA and appropriate social media use in health care.As you begin to consider the assessment, it would be an excellent choice to complete the Breach of Protected Health Information (PHI) activity. What percentage of your income should you spend on life insurance? Participating whole life insurance allows the policy owner to participate in the insurance company's profits. For example, if the Medicare allowed amount is $100, but your rate is $160, you must accept $100 and cannot balance bill the patient for the $60 difference. Be sure to include essential HIPAA information. Competency 1: Describe nurses' and the interdisciplinary team's role in informatics with a focus on electronic health information and patient care technology to support decision making. One of the leading public health issues of concern is the people's exposure to biological hazards in the ever-expanding tr One of the leading public health issues of concern is the people's exposure to biological hazards in the ever-expanding transport infrastructure in common understandings. $57 also = 95% of $60 Insurance Denial Claim Appeal Guidelines. Patient has met any applicable deductible and submits Physician s bill to Insurer. For example, if the Medicare allowed amount is $100, a nonparticipating provider starts at $95 (95% of the Medicare fee schedule rate) and then adds the limiting charge (115% of the nonparticipating provider rate). Fees for covered services, including yearly (calendar year) enrollment fees, deductibles, copayments,pharmacy copayments, and other cost-shares based on TRICARE-allowable charges, apply toward your catastrophic cap. Steps to take if a breach occurs. All our content are education purpose only. BCBSKS staff is authorized to adjust MAP for the physician in light of such agreements, under the following terms: 1. Update your browser to view this website correctly.Update my browser now, Troubleshooting when your provider refuses to file a claim, Participating, non-participating, and opt-out providers, (Make a selection to complete a short survey), Coordinating Medicare with Other Types of Insurance, Cost-Saving Programs for People with Medicare, Medicare Prescription Drug Coverage (Part D), Planning for Medicare and Securing Quality Care, Getting an Advance Beneficiary Notice (ABN) from your provider, Care coordination after a hospital or skilled nursing facility (SNF) stay, troubleshooting steps to help resolve the problem, State Health Insurance Assistance Program (SHIP), durable medical equipment (DME) suppliers, State Health Insurance Assistance Program, These providers are required to submit a bill (file a. Determine which of the following individuals is not eligible for coverage under Medicare without paying a premium. Technological advances, such as the use of social media platforms and applications for patient progress tracking and communication, have provided more access to health information and improved communication between care providers and patients.At the same time, advances such as these have resulted in more risk for protecting PHI. (Doesn't apply to active duty service members). ASHA has developed three MPPR scenarios to illustrate how reductions are calculated. The Allowable Amount for non-Participating Pharmacies will be based on the Participating Pharmacy contract rate. Note that hospital outpatient audiology services are paid under the hospital outpatient payment system (OPPS). assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services, Person responsible for paying the charges, does not contract with insurance plan/NON PARTICIPATING PROVIDER, under coordination of benefits, the carrier for the parent who has a birthday earlier in the year is primary. Mutual insurers are corporations owned by the policyowners, who elect the board of directors. This is paid during the time of the visit. Apply to become a tutor on Studypool! Total spent this period across all three Apple Health contracts, Apple Health Managed Care, Fully Integrated Managed Care and Integrated Foster Care, for non-participating providers was $164 million, a $14 million increase from last year. Many nurses and other health care providers place themselves at risk when they use social media or other electronic communication systems inappropriately. personal training Individuals age 64 or younger General Service covered by Medicare 1. Reimbursement for non-participating providers (non-pars) is more complex. WEEK 7 DISCUSSION. It is mostly patient responsibility and very rarely another payor pays this amount. Logging out of public computers. Non-Participating Provider means a person, health care provider, practitioner, facility or entity acting within their scope of practice and licensure, that does not have a written agreement with the Contractor to participate in a managed care organization 's provider network, but provides health care services to enrollees. The appearance of hyperlinks does not constitute endorsement by the DHA of non-U.S. Government sites or the information, products, or services contained therein. She is just the best patient Ive ever had, and I am excited that she is on the road to recovery. What not to do: Social media. Non-participating providers can charge you up to 15% more than the allowable charge that TRICARE will pay. All the information are educational purpose only and we are not guarantee of accuracy of information. Allowed amounts are generally based on the rate specified by the insurance. In this assessment, assume you are a nurse in an acute care, community, school, nursing home, or other health care setting. Physical, occupational, and speech therapy 2. The Co-pay amount is usually specified in the insurance card copy. Is a participating provider in a traditional fee-for-service plan always paid more for a service than a nonparticipating provider who does not accept assignment? Consider performing a health history on someone that may not be able In other words it is the total charge value of the claim. DS other than your primary care manager for any non-emergency services without a referral. Examples include: Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies. To successfully prepare to complete this assessment, complete the following: individuals age 65 and older, disabled adults, individuals disabled before age 18, spouses of entitled individuals, individuals with end stage renal disease, and retired federal employees enrolled in the civil service retirement system, Pregnant women, infants, immigrants, individuals 64 or younger, individuals with terminal cancer, individuals addicted to narcotics, a form given to patients when the practice thinks that a service to be provided will not be considered medically necessary or reasonable by medicare, a group of insurance plans offered under medicare part B intended to provide beneficiaries with a wider selection of plans, A type of federally regulated insurance plan that provides coverage in addition to medicare part B, non participating physicians cannot charge more than 115 percent of the medicare fee schedule on unassigned claims, an organization that has a contract with Medicare to process insurance claims from physicians, providers, and suppliers, Provider Quality Reporting PPO plan participants are free to use the services of any provider within their network. Before implement anything please do your own research. Identify evidence-based approaches to mitigate risks to patients and health care staff related to sensitive electronic health information. "Non-Par" A provider that has NO contract and can bill the patient over and above the amount of the allowable fee, How to handle phones calls in the healthcare. d) You can expect to receive a policy dividend from a stock company. All Part B services require the patient to pay a 20% co-payment. Use the "Clear" button to change the year or contractor. This information will serve as the source(s) of the information contained in your interprofessional staff update. CPT 81479 oninvasive Prenatal Testing for Fetal Aneuploidies, CPT CODE 47562, 47563, 47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY, Top 13 denials in RCM and how to prevent the denials, CPT Code 99201, 99202, 99203, 99204, 99205 Which code to USE. Featured In: March 2023 Anthem Blue Cross Provider News - California. Blue Cross regularly audits our allowable charge schedule to ensure that the allowable charge amounts are accurate. Sure enough, the four boys ranging in age from five to 11 sported ties and jackets, impeccably dressed for a special occasion: their dads swearing-in as chief justice of the Florida Supreme Court. When enrolling as a participating provider, you are required to bill on an assignment basis and accept the Medicare allowable fee as payment in full. System (PQRS), a program that provides a potential bonus for performance on selected measures addressing quality of care. Suite 5101 Choose one of the articles from the RRL assignment, and discuss the findings. Paid amount = Allowed amount (Co-pay / Co-insurance + Deductible). Such hyperlinks are provided consistent with the stated purpose of this website. After reviewing the definitions in rules or provided by the health insurers, OFM found that: ** Billed amount is not defined in rule by any of the states with an APCD. However, you are responsible for collecting the full amount (the limiting charge) from the patient and Medicare will send reimbursement directly to the patient for the 80%. These are the countries currently available for verification, with more to come! A Health Maintenance Organization (HMO) is a system of health care that provides managed, pre-paid hospital and medical services to its members. More answers. Are you in need of an additional source of income? Our best tutors earn over $7,500 each month! number(info) You should always bill your usual charge to Blue Cross regardless of the allowable charge. a. The two columns of the PPO plan specify how charges from both the Participating and Non-Participating Providers will be applied for the member. i need a 15-page final paper. The amount you pay when traveling to and from your appointment. Selma Company sold a total of 18,500 units during the year. email@example.com. If they accept assignment for a particular service, they can't bill the patient for any additional amounts beyond the regular Medicare deductible and coinsurance, for that specific treatment. teaching plan Find your TRICARE costs, including copayments. Opt-out providers do not bill Medicare for services you receive. Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese, Fundamentals of Financial Management, Concise Edition. Non-participating providers don't have to accept assignment for all Medicare services, but they may accept assignment for some individual services. Educate staff on HIPAA and appropriate social media use in health care. -an amount set on a Fee Schedule of Allowance. Select from any of the following options, or a combination of options, the focus of your interprofessional staff update: Conduct independent research on the topic you have selected in addition to reviewing the suggested resources for this assessment. - A participating provider is one who voluntarily and in advance enters into an agreement in writing to provide all covered services for all Medicare Part B beneficiaries on an assigned basis. The post states, "I am so happy Jane is feeling better. The relative weighting factor (relative value unit or RVU) is derived from a resource-based relative value scale. What evidence relating to social media usage and PHI do interprofessional team members need to be aware of? Meaningful use of electronic health records (EHR). It is the Amount charged for each service performed by the provider. Request a Discount. At the same time, they need to be able distinguish between effective and ineffective uses of social media in health care.This assessment will require you to develop a staff update for the interprofessional team to encourage team members to protect the privacy, confidentiality, and security of patient information.Demonstration of Proficiency Pregnant women 2. Select from any of the following options, or a combination of options, the focus of your interprofessional staff update: presence of policy dividends. All Rights Reserved. Afterward, you should receive from Medicare a, The limiting charge rules do not apply to, Medicare will not pay for care you receive from an. The payment amount is $60.00 then the remaining $20.00 is the co-insurance amount. These costs don't apply to your catastrophic cap. Using the LIFO method, compute the cost of goods sold and ending inventory for the year. Describe the security, privacy, and confidentially laws related to protecting sensitive electronic health information that govern the interdisciplinary team. Review the infographics on protecting PHI provided in the resources for this assessment, or find other infographics to review. For Walmart Stores, Inc., determine the amounts of change in million and the percent of change (round to one decimal place) from the prior year to the recent year for: Identify the components of GDP by decoding the formula GDP = C + I + G + (X - M). Individuals with end-stage renal disease Might not be eligible for Medicare coverage 1. D, National Response Today, when most people with Medicare see their doctors, they are generally responsible for paying Medicare's standard coinsurance, but do not face additional or surprise out-of-pocket charges. A stock insurer is referred to as a nonparticipating company because policyholders do not participate in dividends resulting from stock ownership. THIS IS FOR WEEK 7 NR-439 RN-BSN EVIDENCE BASED PRACTICE AT CHAMBERLAIN Applying and Sharing Evidence to Practice (graded) After the data have been analyzed, conclusions are made regarding what the findings mean. By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria: These infographics serve as examples of how to succinctly summarize evidence-based information. the provider receives reimbursement directly from the payer. \text{Beginning inventory} & 4,000 & \$\hspace{5pt}8.00\\ "You have recently completed your annual continuing education requirements at work and realize this is a breach of your organization's social media policy. (9.5), No, a participating provider in a traditional fee-for-service plan does not always get paid more for a service than a nonparticipating provider who does not accept assignment. If you see several doctors as part of an appointment, or have additional tests, you may have more than one cost-share. Really great stuff, couldn't ask for more. Sharing patient information only with those directly providing care or who have been granted permission to receive this information. Please help us improve MI by filling out this short survey. Deductible: How does BMW segment its consumers? The allowable fee for a nonparticipating provider is reduced by five percent in comparison to a participating provider; in other words, the allowable fee for nonparticipating providers is 95% of the Medicare fee schedule allowed amount, whether or not they choose to accept assignment. Develop a professional, effective staff update that educates interprofessional team members about protecting the security, privacy, and confidentiality of patient data, particularly as it pertains to social media usage. All out of pocket charges are based on the individual state's payment for that service. A nonparticipating company is sometimes called a (n) stock insurer. The limiting charge is 115% of 95% of the fee schedule allowed amount. of this agreement. To calculate the reimbursement, use the following formula: MPFS amount x 80% = This is the allowed . Why does location matter for car insurance? The maximum amount TRICARE will pay a doctor or other provider for a procedure, service, or equipment. financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter. To calculate the reimbursement, use the following formula: MPFS amount x 80% = This is the allowed charge. Since some plans have cost-shares that are a percentage of the charge, a lower rate helps keep your costs down. ASHA asked CMS for clarification regarding audiology and CMS responded that the facility rate applied to all facility settings for audiology services. In this assessment, assume you are a nurse in an acute care, community, school, nursing home, or other health care setting. Non-participating provider. See also: Medicare CPT coding rules for audiologists and speech-language pathologists . To successfully prepare to complete this assessment, complete the following: The maximum reimbursement the members health policy allows for a specific service. January - 2023. Participating Provider contracts with a health insurance plan and acceots whatever the plan pays for procedures or services preformed. Physical, occupational, and speech therapy, means "waiver of liability statement issued as required by payer policy", Means "notice of liability issued, voluntary under payer policy.". Osteoarthritis is a type of arthritis that causes alterations of bone structure thus causing motion difficulties due to jo Osteoarthritis is a type of arthritis that causes alterations of bone structure thus causing motion difficulties due to joint degeneration. The Allowable Amount will not include any additional payments that may be permitted under the Medicare laws or regulations which are not directly attributable to a specific claim, including, but not limited to, disproportionate share and graduate medical education payments. Limiting charge (*nonPAR collects*) = 115% * $57 = $65.55 The billed amount for a specific procedure code is based on the provider. BeginninginventoryPurchasesduringyearQuantity4,00016,000UnitCost$8.0012.00. Many nurses and other health care providers place themselves at risk when they use social media or other electronic communication systems inappropriately. Thats why it's usually less expensive for you to use a network provider for your care. All the contents and articles are based on our search and taken from various resources and our knowledge in Medical billing. For more information, contact your, If you pay the full cost of your care up front, your provider should still submit a bill to Medicare. Endowment policies have cash values which will build up after a minimum period, and this differs from product to product. Individuals addicted to narcotics 3. Medicare benefits are available to individuals in how many beneficiary categories? Your matched tutor provides personalized help according to your question details. The provider agrees to accept what the insurance company allows or approves as payment in full for the claim; the patient is responsible for paying any copayment and/or coinsurance amounts, Health insurance plans may include this, which usually has limits of $1,000 or $2,000, Assists providers in the overall collection of appropriate reimbursement for services rendered, Person responsible for paying the charges, Contracts with a health insurance plan and accepts whatever the plan pays for procedures or services performed; not allowed to bill patients for the difference between the contracted rate and their normal fee, Also known as an out-of-network provider; does not contract with the insurance plan, and patients who elect to receive care from nonPARs will incur higher out-of-pocket expenses; the patient is usually expected to pay the difference between the insurance payment and the provider's fee, The insurance plan responsible for paying healthcare insurance claims first, States that the policyholder whose birth month and day occurs earlier in the calendar year holds the primary policy for dependent children, The financial record source document used by healthcare providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter; also called a superbill in the physician's office; called a chargemaster in the hospital, Known as the patient account record in a computerized system; a permanent record of all financial transactions between the patient and the practice, Also known as the day sheet; a chronologic summary of all transactions posted to individual patient ledgers/accounts on a specific day, The electronic or manual transmission of claims data to payers or clearinghouses for processing, A public or private entity that processes or facilitates the processing of nonstandard data elements (e.g., paper claim) into standard data elements (e.g., electronic claim); also convert standard transactions (e.g., electronic remittance advice) received from payers to nonstandard formats (e.g., remittance advice that looks like an explanation of benefits) so providers can read them, A clearinghouse that involves value-added vendors, such as banks, in the processing of claims; using one of these is more efficient and less expensive for providers than managing their own systems to send and receive transactions directly from numerous entities, Also known as electronic media claim; a series of fixed-length records (e.g., 25 spaces for patient's name) submitted to payers as a bill for healthcare services, The computer-to-computer transfer of data between providers and third-party payers (or providers and healthcare clearinghouses) in a data format agreed upon by sending and receiving parties, Required to use the standards when conducting any of the defined transactions covered under HIPAA, Contains all required data elements needed to process and pay the claim (e.g., valid diagnosis and procedure/service codes, modifiers, and so on), A set of supporting documentation or information associated with a healthcare claim or patient encounter; this information can be found in the remarks or notes fields of an electronic claim or paper-based claim forms; used for medical evaluation for payment, past payment audit or review, and quality control to ensure access to care and quality of care, A provision in group health insurance policies intended to keep multiple insurers from paying benefits covered by other policies; it also specifies that coverage will be provided in a specific sequence when more than one policy covers the claim, Involves sorting claims upon submission to collect and verify information about the patient and provider, The process in which the claim is compared to payer edits and the patient's health plan benefits to verify that the required information is available to process the claim, the claim is not a duplicate, payer rules and procedures have been followed, and procedures performed or services provided are covered benefits, Any procedure or service reported on the claim that is not included on the master benefit list, Procedures and services provided to a patient without proper authorization from the payer, or that were not covered by a current authorization, An abstract of all recent claims filed on each patient; this process determines whether the patient is receiving concurrent care for the same condition by more than one provider, and it identifies services that are related to recent surgeries, hospitalizations, or liability coverage, The maximum amount the payer will allow for each procedure or service, according to the patient's policy, The total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the insurance company is obligated to pay any benefits, The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid, The fixed amount the patient pays each time he or she receives healthcare services, Sent to the provider, and an explanation of benefits (EOB) is mailed to the policyholder and/or patient, The payers deposit funds to the provider's account electronically, Are organized by month and insurance company and have been submitted to the payer, but processing is not complete, include those that were rejected to an error or omission (because they must be reprocessed), Filed according to year and insurance company and include those for which all processing, including appeals, has been completed, Are organized according to date of service because payers often report the results of insurance claims processed on different patients for the same date of service and provider, Organized by year and are generated for providers who do not accept assignment; the file includes all unassigned claims for which the provider is not obligated to perform any follow-up work, Documented as a letter signed by the provider explaining why a claim should be reconsidered for payment; if appropriate, include copies of medical record documentation, Any medical condition that was diagnosed and/or treated within a specified period of time immediately preceding the enrollee's effective date of coverage, The amounts owed to a business for services or goods provided, Also known as the Truth In Lending Act; requires providers to make certain written disclosures concerning all finance charges and related aspects of credit transactions (including disclosing finance charges expressed as an annual percentage rate), Established the rights, liabilities, and responsibilities of participants in electronic fund transfer systems, Prohibits discrimination on the basis of race, color, religion, national origin, sex, marital status, age, receipt of public assistance, or good-faith exercise of any rights under the Consumer Credit Protection Act, Fair Credit and Charge Card Disclosure Act, Amended the Truth In Lending Act; requires credit and charge card issuers to provide certain disclosures in direct mail, telephone, and other applications and solicitations for open-ended credit and charge accounts and under other circumstances, Amended the Truth in Lending Act; requires prompt written acknowledgement of consumer billing complains and investigation of billing errors by creditors, Protects information collected by consumer reporting agencies such as credit bureaus, medical information companies, and tenant screening services, Fair Debt Collection Practices Act (FDCPA), States that third-party debt collectors are prohibited from employing deceptive or abusive conduct in the collection of consumer debts incurred for personal, family, or household purposes, Also known as a delinquent account; one that has not been paid within a certain time frame (e.g., 120 days), This is generated when trying to determine whether a claim is delinquent; shows the status (by date) of outstanding claims from each payer, as well as payments due from patients, Understanding Health Insurance, Chapter 5 Ter, Understanding Health Insurance, Chapter 3 Ter, Understanding Health Insurance Abbreviations,, Donald E. Kieso, Jerry J. Weygandt, Terry D. Warfield, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese, Daniel F Viele, David H Marshall, Wayne W McManus.