When a Provider Receives a Partial Payment on a Claim

question 97

Multiple Choice

When a provider receives a partial payment on a claim because the amount billed was in excess of the maximum allowed charge, this is a:

• A) denial.
• B) downcode.
• C) determination.
• D) disallowance.

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Definitions:

Data Analytics

The examination of data sets to draw conclusions and insights, often using specialized systems and software, to inform decision-making.

Sentiment Analysis

A method in data analysis that identifies and categorizes opinions or emotions within text data to determine the writer's or speaker's attitude towards a particular topic.

Coverage Error

A statistical error that occurs when some members of the target population are not adequately represented in the sample.

Echo Effect

The phenomenon where information, ideas, or beliefs are reinforced through repetition within a closed system, limiting exposure to diverse viewpoints.