Glossary of Health Insurance Terms

See "International Classification of Diseases."

See "Individual Consideration."

See "International Classification of Diseases."

See "Internal Control Number" and "Inquiry Control Number."

The card issued to identify a member of BCBSKS and what coverage the member and any family members on the policy have.

A charge billable on the date that the service is performed or the supply or equipment is delivered.

See "Indemnity contract."

See "Contract indemnified payment limitation balance."

See "Indemnity contract."

A patient contract that pays a set amount for a specific service, balances are patient's financial responsibility.

By using modifier "22" immediately following the procedure code, a provider may request special review of the service because of unusual circumstances. Additional information must accompany the claim. This information should document the unusual circumstances.

A unique numeric identifier for each eligible provider that gives BCBSKS an audit trail of who performed the services and who was reimbursed for those services. See "Common pay provider number" and "Claims filing". Without this information BCBSKS is not able to determine whom to pay.

When a patient's contract requires that a coinsurance amount be the patient's responsibility, there is also a total amount that the patient has as out-of-pocket expense for covered services before BCBSKS begins to reimburse 100 percent of the allowed charge; this amount is referred to as the individual stop loss.

The first step or first level in the BCBSKS appeal procedure. A peer consultant makes the decision at this level.

When a patient is hurt during work-related duties, it is referred to as injured on the job, work comp, work compensation, or work related injury. These services are always filed with the Workers' Compensation carrier first.

See "Accidental injury."

A patient who is staying in the hospital and receiving room, board and general nursing care.

The unique numeric sequence that identifies a specific contact to CSC.

Any person entitled to receive medical, surgical and ancillary services pursuant to the terms of BCBSKS underwritten or administered contracts referencing contracting providers.

See “BlueCard Program.”

See "Medicare Part A Intermediary."

The unique sequence of numeric characters that BCBSKS assigns to each claim as it is imaged and before it is processed.

An alpha-numeric coding system that identifies the complaints, symptoms and diagnosis of a patient.

See "Experimental or Investigational."