Best Answer · By JanBask Business Analyst Expert
Answered on Jun 11, 2019
Below are the important fields that will be used dealing with Healthcare claims,
Date of service - It denotes the date of the service used by the Insured
Procedure code - It represents the code id for the Procedure used by the Insured
Diagnosis codes - It is a code which represent description of illness
Price for each service line - Premium paid by the Insured for each service
Deductible - The amount insured pay for covered health care services before your insurance plan starts to pay.
Co-pay - It is a fixed amount paid by an insured for covered services.
Coinsurance - It is the amount generally a fixed percentage, an insured must pay against a claim after the deductible.
Allowed amount for the claim - It is a max amount, the plan will pay for a covered health care services.
Disallowed amount in the total claim - It is the amount which is not covered in the claim
Subscriber - It refers to the person who pays the insurance premium amount.
Provider - Providers are basically who offer Healthcare services
