Glossary of Health Insurance Terms

Uniform Bill 1992. The claim form used to bill facility charges to Medicare Part A and Blue Cross of Kansas. It replaced the UB-82.

See "Uniform Claim Form."

See "Usual, Customary and Reasonable."

The separating of a procedure into its many components, resulting in payment for each component rather than a global price for the entire procedure. One or more components of a procedure may be broken out and paid separately. See "Content of Service" and "Bundling."

See "Unlisted Procedure."

Usually refers to the company or the procedure of being financially responsible for the costs of the care contracted for. The company receives premiums from the employer or from the member/member -patient which may or may not be enough to cover the actual expense of the care received. The underwriter -company takes full financial responsibility for the payment of those covered services regardless of the total amount of monies received in premiums.

Usually refers to the UB-92 or the HCFA-1500 -12-90 documents that are used by providers to request reimbursement for medical services.

Health Care Financing Administration assigned specific group of numeric characters for every doctor in the United States.

The three digit numeric representation of time/regions/number of services performed on a given date.

The procedure codes that are not specific to any service. When using these, you must identify what service or item you have provided.

See "Unlisted Procedure."

The intentional or accidental act of changing a procedure code, such as a CPT code digit, to reflect a higher intensity of care than was actually performed and thus receiving a higher level of reimbursement.

See "Unique Physician Identifying Number."

See "Utilization Review."

See "Utilization Review Accreditation Commission."

The fee most commonly charged for a given service by the provider to the general public. This charge cannot be higher to BCBSKS if the provider is contracting.

The formally established process for determining the appropriateness of services rendered to our members/members -patients and of payments, through an analysis of medical necessity. Proper documentation ensures that the services in question are reimbursed appropriately. See "Medical Recordkeeping" and "Subjective, Objective, Assessment and Plan Documentation."

A Washington based, nonprofit corporation, dedicated to improving the quality of utilization review by providing a method of evaluation and accreditation of utilization review programs and PPOs.