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.
ACH Payments – Automated Clearing House payments, a type of electronic payment system used to transfer funds between banks.
ANSI 834 – An eligibility request to verify coverage for a procedure and/or timeframe.
ANSI 835 – An EDI standard for electronic remittance advice, used for the exchange of payment information between healthcare providers and insurance companies.
ANSI 837 – An electronically submitted healthcare insurance claim submitted to an insurance company or clearinghouse.
ANSI X12 – A set of EDI standards developed by the American National Standards Institute (ANSI) for use in the United States.
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.
Appeal – The process of requesting a review of a denied health insurance claim. See also Insurance Appeal.
Authorization – The process of verifying that a customer's credit card information is valid and has sufficient funds available for a transaction.
Automated Billing – The process of generating and sending bills or invoices automatically, without manual intervention.
AutoPay – A BillFlash feature, AutoPay allows BillFlash to electronically debit your payment from your authorized account each month after presenting your invoice online.
Bill of Rights – A document or set of guidelines that outlines the rights and protections afforded to individuals receiving medical care or treatment.
Biller – A business or practice which sends statements to their customers or patients through BillFlash.
Billing Application – An application that a Biller uses to generate their statements. See also Billing Software.
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.
Billing Software – A computer program used to manage and automate the billing process for a business.
Billing Statements – A summary of a customer's billing activity, including charges, payments, and balances.
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.
Charge Capture – The process of recording all of the charges associated with a patient encounter, including medical services, supplies, and any other charges.
Charge Entry – The process of entering patient encounter charges into the billing system.
Chargeback – A transaction that is reversed by a customer's credit card issuer, typically due to a dispute over the transaction.
Claim Scrubbing – The process of reviewing and verifying insurance claims for accuracy and completeness before they are submitted to payers.
Claim Submission – The process of submitting insurance claims to payers for reimbursement.
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
Coding – The process of assigning procedure and diagnosis codes to medical services for the purpose of submitting health insurance claims and determining reimbursement rates
Collections – The process of attempting to recover a past-due debt owed by an individual or business.
Collections Management – The process of collecting past-due payments from patients and insurance payers for outstanding balances.
Compliance – Adhering to legal and regulatory requirements issued by the government or other regulatory entities.
Coordination of Benefits (COB) – The process of coordinating payment for medical services between multiple insurance providers when a patient has multiple insurance plans.
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.
Data Analytics – The process of analyzing data from the revenue cycle to identify trends, inefficiencies, and opportunities for improvement.
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.
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.
Debt Validation – The process of verifying that a medical debt is accurate and legally collectible.
Denials Management – The process of identifying, researching, and appealing insurance claims that have been denied for payment.
Denied Claim – A claim that has been rejected by an insurance company for payment.
Diagnosis-Related Group (DRG) – A system for classifying medical conditions and procedures into groups for the purpose of determining reimbursement rates.
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.
EDI Document – An electronic business document, such as an invoice, purchase order, or shipping notice, exchanged between organizations using EDI.
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.
EDI Network – An electronic network used for the exchange of EDI transactions between organizations.
EDI Standards – A set of guidelines and protocols for EDI transactions, including document formats and communication protocols.
EDI Transaction – A standardized electronic exchange of business data between two organizations.
EDI Translation – The process of converting EDI documents into a format that can be used by a specific organization's computer systems.
EDI VAN – An EDI Value-Added Network, a third-party service provider that provides EDI services, including EDI document translation, mapping, and communication.
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.
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.
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.
Explanation of Benefits (EOB) – A document provided by a health insurance provider that explains the coverage and payment of a healthcare claim.
Health Insurance Claim – A request for payment made to a patient's health insurance provider for medical services.
Insurance Appeal – A request made to an insurance company to reconsider a denied claim.
Insurance Claim – A request made to an insurance company for payment of medical expenses.
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.
International Classification of Diseases (ICD) Codes – A standardized system of codes used to describe medical diagnoses for the purpose of billing and reimbursement.
ICD 10 – The current system used in the United States for describing medical diagnoses for the purpose of billing and reimbursement.
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.
Medical Billing – The process of submitting and collecting payment for medical services.
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.
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.
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.
Payment Gateway – An online payment processing service that enables merchants to accept payments from customers through a variety of payment methods.
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.
Payment Posting – The process of recording payments received from insurance payers and patients.
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.
Payment Security – The measures taken to protect sensitive payment information during the payment processing process.
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.
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.
Prior Authorization – The process of obtaining approval from a health insurance provider before providing a medical service.
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.
Remittance Advice – An electronic or paper notification from a payer indicating the payment amount and any adjustments made to a claim.
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.
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.
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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