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Explore definitions and key terms related to the billing, payment, and collections industry.
Accounts Receivable Management – The process of managing A/R and outstanding balances owed by patients and insurance payers. See also: What is Accounts Receivable Management?
ACH Payments – Automated Clearing House payments, a type of electronic payment system used to transfer funds between banks. See also: What are ACH Payments?
ANSI 834 – An eligibility request to verify coverage for a procedure and/or timeframe. See also: What is ANSI 834?
ANSI 835 – An EDI standard for electronic remittance advice, used for the exchange of payment information between healthcare providers and insurance companies. See also: What is ANSI 835?
ANSI 837 – An electronically submitted healthcare insurance claim submitted to an insurance company or clearinghouse. See also: What is ANSI 837?
ANSI X12 – A set of EDI standards developed by the American National Standards Institute (ANSI) for use in the United States. See also: What is ANSI X12?
API – API stands for “Application Programming Interface.” An API is a set of rules, protocols, and tools for building software and applications. It acts as an intermediary between two software systems, allowing them to communicate with each other and exchange data. See also: What are APIs?
Appeal – The process of requesting a review of a denied health insurance claim. See also Insurance Appeal. See also: What are Appeals?
Authorization – The process of verifying that a customer's credit card information is valid and has sufficient funds available for a transaction. see also: What are Authorizations?
Automated Billing – The process of generating and sending bills or invoices automatically, without manual intervention. See also: What is Automated Billing?
AutoPay – A BillFlash feature, AutoPay allows BillFlash to electronically debit your payment from your authorized account each month after presenting your invoice online. See also: What is AutoPay?
Bill of Rights – A document or set of guidelines that outlines the rights and protections afforded to individuals receiving medical care or treatment. See also: What is the Patient Bill of Rights?
Biller – A business or practice which sends statements to their customers or patients through BillFlash. See also: Key Player in Medical Billing
Billing Application – An application that a Biller uses to generate their statements. See also Billing Software. See also: What is a Billing Application?
Billing History – A record of a customer's billing activity, including past invoices and payments.
Billing Service – A third-party organization employed to handle the outsourced billing process for another business or healthcare practice. See also Revenue Cycle Management Services. See also: What is a Billing Service?
Billing Software – A computer program used to manage and automate the billing process for a business. See also: 7 Tips for Choosing a Medical Billing Software
Billing Statements – A summary of a customer's billing activity, including charges, payments, and balances. See also: Understanding Patient Billing Statements
Card Account Updater (CAU) – A BillFlash Pay Services feature, Card Account Updater (CAU) reduces the number of declined or late payments due to expired card information by automatically retrieving updated card details from Visa, Mastercard, and Discover when a new card is issued to your customers. See also: What is a Card Account Updater?
Charge Capture – The process of recording all of the charges associated with a patient encounter, including medical services, supplies, and any other charges. See also: What is Charge Capture?
Charge Entry – The process of entering patient encounter charges into the billing system. See also: What is Charge Entry?
Chargeback – A transaction that is reversed by a customer's credit card issuer, typically due to a dispute over the transaction. See also: What is a Chargeback?
Claim Scrubbing – The process of reviewing and verifying insurance claims for accuracy and completeness before they are submitted to payers. See also: What is Claim Scrubbing?
Claim Submission – The process of submitting insurance claims to payers for reimbursement. See also: What is a Claim Submission?
Clearinghouse – A clearinghouse in medical billing acts as an intermediary between healthcare providers and insurance companies, helping to facilitate the processing of medical claims and improve the efficiency of the billing process. See also: What is a Medical Billing Clearinghouse?
Coding – The process of assigning procedure and diagnosis codes to medical services for the purpose of submitting health insurance claims and determining reimbursement rates. See also: What is Medical Coding?
Collections – The process of attempting to recover a past-due debt owed by an individual or business. See also: What You Need to Know About Medical Debt Collections
Collections Management – The process of collecting past-due payments from patients and insurance payers for outstanding balances. See also: What is Medical Collections Management?
Compliance – Adhering to legal and regulatory requirements issued by the government or other regulatory entities. See also: What is Healthcare Compliance?
Coordination of Benefits (COB) – The process of coordinating payment for medical services between multiple insurance providers when a patient has multiple insurance plans. See also: What is Coordination of Benefits?
Credit Card Processing – The process of accepting and processing payments made with credit cards.
Current Procedural Terminology (CPT) Codes – A standardized system of codes used to describe medical procedures and services for the purpose of billing and reimbursement. See also: What are Current Procedural Terminology Codes?
Data Analytics – The process of analyzing data from the revenue cycle to identify trends, inefficiencies, and opportunities for improvement. See also: Maximizing Revenue Cycle Management with Analytics and Reporting
Data File – The file generated by the Biller's billing application which contains the statement data for a defined period of statements to be produced and mailed.
Debt Collection Letter – A written notice sent by a creditor or debt collection agency to a debtor, demanding payment of a debt. See also: The Importance of Compassionate Patient Collections in Today's Healthcare Landscape
Debt Management Plan – A plan that helps individuals manage their debts and repay them over time. See also Payment Plan.
Debt Settlement – The process of reaching an agreement with a medical debt collection agency to settle a medical debt for less than the full amount owed. See also: What is Debt Settlement?
Debt Validation – The process of verifying that a medical debt is accurate and legally collectible. See also: What is Medical Debt Validation?
Denials Management – The process of identifying, researching, and appealing insurance claims that have been denied for payment. See also: How Does Denials Management Work?
Denied Claim – A claim that has been rejected by an insurance company for payment. See also: What is a Denied Claim?
Diagnosis-Related Group (DRG) – A system for classifying medical conditions and procedures into groups for the purpose of determining reimbursement rates. See also: What is the Diagnosis-Related Group?
eBill Service – A free BillFlash service that creates a paperless Online eBill with every approved bill.
eBill Notice – A BillFlash service that delivers a paperless eBill Notice via email and/or text message notifying patients that their bills are available to view and pay online.
EDI (Electronic Data Interchange) – The electronic exchange of business documents between organizations in a standardized format. See also: What Is Electronic Data Interchange?
EDI Document – An electronic business document, such as an invoice, purchase order, or shipping notice, exchanged between organizations using EDI. See also: What is an EDI Document?
EDI Mapping – The process of defining the relationships between data elements in an EDI document and the corresponding fields in an organization's computer systems. See also: What is EDI Mapping?
EDI Network – An electronic network used for the exchange of EDI transactions between organizations. See also: What is an EDI Network?
EDI Standards – A set of guidelines and protocols for EDI transactions, including document formats and communication protocols. See also: What are EDI Standards?
EDI Transaction – A standardized electronic exchange of business data between two organizations. See also: What are EDI Transactions?
EDI Translation – The process of converting EDI documents into a format that can be used by a specific organization's computer systems. See also: What are EDI Transations?
EDI VAN – An EDI Value-Added Network, a third-party service provider that provides EDI services, including EDI document translation, mapping, and communication. See also: What is an EDI VAN?
EFT – Any transfer of funds initiated through a terminal, telephone, computer or magnetic tape for the purpose of instructing or authorizing a financial institution to debit or credit an account. See also: What is an EFT?
EHR or EMR – EHR stands for “Electronic Health Record,” also known as EMR (Electronic Medical Record). It is a digital version of a patient's medical history and healthcare information, including demographic information, medical diagnoses, medications, test results, treatment plans, and other relevant clinical data. See also: What is an EHR/EMR?
Electronic Invoicing – The process of generating and sending invoices electronically, as opposed to printing and mailing paper invoices.
Electronic Medical Billing (EMB) – The process whereby a healthcare provider or third-party billing company submits a bill or claim electronically to a patient or third-party payer (usually an insurance company). View our article on The Top 5 Advantages of Electronic Medical Billing Services.
Embedded Payments – The ability to pay electronically using a preferred payment method directly on a practice's website. See also: What are Embedded Payments?
Explanation of Benefits (EOB) – A document provided by a health insurance provider that explains the coverage and payment of a healthcare claim. See also: What is Explanation of Benefits?
Health Insurance Claim – A request for payment made to a patient's health insurance provider for medical services. See also: What is a Health Insurance Claim?
Insurance Appeal – A request made to an insurance company to reconsider a denied claim. See also: What is a Health Insurance Appeal?
Insurance Claim – A request made to an insurance company for payment of medical expenses. See also: What is a Health Insurance Claim?
Integrated Collections Services – A BillFlash service used to simplify the process of flagging accounts that are eligible for collection recovery efforts. BillFlash Integrated Collections Service works with your existing practice management application, streamlining the process of sending past-due A/R to collections where our team of Recovery Specialists will implement debt collection best practices to maintain the physician-patient relationship while collecting on past-due accounts.
Interchange Rate – Interchange rate is a fee paid by a merchant's acquiring bank (the bank that processes credit and debit card transactions for the merchant) to the cardholder's issuing bank (the bank that issued the credit or debit card used in the transaction) for each card transaction. The interchange rate is set by the card networks such as Visa, Mastercard, and American Express and is typically a percentage of the transaction amount plus a fixed fee. See also: What is an Interchange Rate?
International Classification of Diseases (ICD) Codes – A standardized system of codes used to describe medical diagnoses for the purpose of billing and reimbursement. See also: What are International Classification of Diseases (ICD) Codes?
ICD 10 – The current system used in the United States for describing medical diagnoses for the purpose of billing and reimbursement. See also: What is ICD-10?
Late Payment Fees – Fees charged to customers who have not paid their bills by the due date.
Liability – The legal responsibility to repay a debt.
Mail Service – BillFlash offers a convenient option to automate invoice and billing management with our Mailed Bills solution, which delivers a professional printed bill through USPS First Class Mail.
Medical Billing Specialist – A professional who specializes in the process of submitting and following up on health insurance claims for payment of medical services. See also: What is a Medical Billing Specialist?
Medical Billing – The process of submitting and collecting payment for medical services. See also: The Process of Medical Billing
Medical Billing Software – Software used to automate the billing processes to help practices get paid faster at a total lower cost, improving workflow efficiencies and maximizing practice cashflow. View our article, 7 Tips for Choosing the Right Medical Billing Software for Your Practice. See also Practice Management Software.
Medical Debt Collection Agency – A company that specializes in collecting medical debts on behalf of healthcare providers. See also Integrated Collections Services.
Merchant Account – An account established by a merchant with a bank or payment processor that enables the merchant to accept credit card payments. View our article, All You Need to Know About Setting Up a Merchant Account.
MyProviderLink.com – A BillFlash service, MyProviderLink.com is the website where Payers can view their statements online (eBills) and make payments online (see SelfPay). In addition, Payers can manage their Delivery Preferences (eBill or Mail) and Payment methods.
NCOALink– An address correction service offered by the United States Postal Service through licensed vendors. NCOALink processing updates individual, family, and business Change-of-Address mailer records before mail is printed. Currently, the NCOALink database covers the previous 18 months of address changes, with new moved information added weekly. electronic typesetting, remaining essentially unchanged.
OfficePay – A BillFlash Pay Services feature, OfficePay allows Billers to receive and process walk-in, mail, and phone payments received from payers.
Online eBill – A BillFlash service, an Online eBill is the online presentation of a statement, viewable at MyProviderLink.com. A free Online eBill is created for each approved bill.
OnlinePay – A BillFlash Pay Services feature, OnlinePay allows Payers to make payments online using our payment portal at MyProviderLink.com.
Patient Encounter – An interaction between a patient and a healthcare provider, including medical services provided and any related billing information.
Patient Responsibility – The portion of a medical bill that is not covered by insurance and must be paid by the patient. See also: How to Calculate Patient Responsibility
Payer – For BillFlash users, Payer refers to the party receiving the billing notification, either through mail, or as an eBill Notice via email and/or text.
Payment Card Industry Data Security Standard (PCI DSS) – A set of security standards designed to ensure the safe handling of credit card information by merchants and payment processors. What is PCI DSS?
Payment Gateway – An online payment processing service that enables merchants to accept payments from customers through a variety of payment methods. See also: Understanding Payment Gateways in Healthcare
Payment Method – The type of payment used for a transaction, such as credit card, electronic check, or PayPal.
Payment Portal – A web-based interface that enables customers to view and manage their billing information, including billing statements and payment history. For BillFlash users, this is MyProviderLink.com. See also: Implementing Payment Portals in Healthcare
Payment Posting – The process of recording payments received from insurance payers and patients. See also: What is Payment Posting?
Payment Processing – The process of accepting and reconciling payments from customers.
Payment Provider – A company that offers payment processing services to merchants, such as a payment gateway or merchant account provider. See also: The Role of Payment Providers in Healthcare
Payment Security – The measures taken to protect sensitive payment information during the payment processing process. See also: Maintaining Payment Security in Your Medical Practice
Pay Services – A BillFlash service, Pay Services provides comprehensive payment solutions for accepting payments in-office, by mail, over the phone, or online, with popular features such as AutoPay, PlanPay, and StoredPay.
Payment Tokenization – The process of securely storing payment information in the form of a token rather than sensitive card data. To learn more about the benefits of payment tokenization, read our article Tokenization: Making Payments Secure and Easy with Payment Services.
PCI Compliance – Payment Card Industry (PCI) compliance refers to the measures a business must take to secure and protect credit card data provided by cardholders and transmitted through card processing transactions. See also: What is PCI Compliance in Healthcare?
PlanPay – A feature of BillFlash Pay Services, PlanPay allows you to set up an automated payment plan to get paid in full over a mutually agreed upon schedule.
Practice Management Software – Practice Management Software is a type of computer software designed to assist healthcare providers in managing their clinical and administrative operations. See also: What is Practice Management Software?
Prior Authorization – The process of obtaining approval from a health insurance provider before providing a medical service. See also: What is Prior Authorization?
Provider – A healthcare provider, such as a hospital, doctor, or laboratory, that provides medical services to patients.
Recurring Payments – Payments that are charged on a regular basis, such as monthly or annually.
Refund – The process of returning funds to a customer for a previously processed transaction.
Reimbursement – The payment made by an insurance company or patient to a healthcare provider for medical services rendered. See also: What are Reimbursements in Healthcare?
Remittance Advice – An electronic or paper notification from a payer indicating the payment amount and any adjustments made to a claim. See also: What is Remittance Advice?
Reseller – The business from which you obtain ongoing support for your BillFlash billing application that generates your statements. A Reseller can be either:
Revenue Cycle Management (RCM) – RCM is the process of managing the flow of revenue from the point of patient care delivery to the final payment of a patient's bill. See also: What is Revenue Cycle Management and Can It Help My Practice Thrive?
Revenue Cycle Management (RCM) Services – A third-party organization that practices contract with to outsource their medical billing and manage their RCM to maximize their revenue and ensure positive practice cashflow. See also Billing Service.
Routing Number – The Federal Reserve assigns a unique 9-digit number to each member bank. This number is found between the colons on the bottom of a check. The routing number is also known as a transit number.
SelfPay – A BillFlash Pay Services feature, SelfPay allows Payers to make payments online using our payment portal at MyProviderLink.com.
Self Pay Patient – A patient who does not have insurance and is responsible for the full cost of their medical services. See also: What is a Self Pay Patient?
Settlement – The process of transferring funds from a merchant's account to the merchant's bank account.
StoredPay – A feature of BillFlash Pay Services, StoredPay allows preferred payment methods to be stored to a users account.
USPS – The United States Postal Service.
Value Added Reseller (VAR) – An independent technology company of software reseller who sells and supports NexTrust's BillFlash application. See also Reseller.
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