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Glossary of Health Insurance Terms

As you explore our site, you may come across an unfamiliar word or term. We've developed a glossary of health care terms we hope will help you.

Select one of the following letters to take you to the part of the alphabet that applies.

A

AACPPY - Average Allowed Charge Per Patient Per Year. See "Kansas Chiropractic Network"

ADL - See "Activities of Daily Living".

Accident - See "Accidental Injury".

Accident Date - Day, month and year injury or accident occurred.

Accidental Injury - Injury to the body caused solely through external, violent and accidental means. This definition has been liberalized to include sprains and strains.

Activities of Daily Living -ADL - Duties performed as part of a patient's daily routine of self-care, such as bathing, dressing and eating.

Actual Acquisition Cost - The provider's net payment made to purchase an item, after taking into account purchasing allowances, discounts and rebates.

Actuary - BCBSKS staff member who decides insurance policy rates as well as conducts various other statistical studies.

Acute Care - Treatment for a short-term or episodic illness or health problem.

ADA - Americans With Disabilities Act.

ADAS - See "Alcohol and Drug Abuse Services".

Administrative Services Only -ASO - An employee group that contracts with BCBSKS to process their claims with their coverage criteria. The group pays for the cost of the services their employees receive, rather than paying premiums.

Adjudication - Processing a claim through a series of edits to determine the proper payment.

Advance Insurance Company - Our subsidiary that sells complete packages of life and disability insurance benefits. The agency representatives are licensed to sell life, accidental, death and dismemberment, and disability insurance. This agency operates completely separate from BCBSKS. The chief operating officer of this agency is a member of BCBSKS Steering Committee.

Agreement - See "Contracting Provider Agreement".

AHA - American Hospital Association.

Allied Health Personnel - Medical care givers who are not in independent practice and are usually under the supervision of a licensed/certified health care professional such as a physician, optometrist, chiropractic physician, dentist, etc.

Allowed Charge - The lesser amount of the actual charge or the maximum allowable payment -MAP, or the patient contract indemnified payment limitation amount.

Alcohol and Drug Abuse Services -ADAS - The State of Kansas department in Social and Rehabilitation Services that is responsible for the certification of Outpatient Substance Abuse Facilities.

Alternative Delivery Systems - All forms of providing health insurance coverage other than the traditional fee for service type of contract.

Alternative Medicine - Health care services outside the traditional medical practice, this type of care can include such therapies as: acupuncture, holistic medicine, homeopathy, non-medical massage therapy, herbal therapy, hypnosis, naturopathy, and biofeedback.

AMA CPT - See "Current Procedural Terminology".

Ambulatory Surgery Center - A facility where operative procedures are performed and the patient is released the same day.

Ancillary Services - Health care such as lab and x-rays.

Anniversary Date - The time each year that the patient's contract is renewed.

AOA - American Optometric Association.

AOPA - American Orthotic and Prosthetic Association.

Appeals Procedure - The process by which a contracting provider may have a claim adjudication or a medical necessity denial reconsidered.

Appeal of Pre-Determination Denial - This is the procedure by which a patient or a provider can have a service reconsidered that has been denied before the service is rendered.

ASC - See "Ambulatory Surgery Center".

ASHA - American Speech and Hearing Association.

ASO - See "Administrative Services Only".

Assignment of Benefits - The procedure by which a patient may have the reimbursement sent to a provider if the provider is one of the types to whom we do not offer contracts, such as opticians, hearing aid dispensers, registered nurses and licensed practical nurses.

If we offer a contract to a particular provider type and a specific provider within that type chooses not to contract , the reimbursement cannot be sent to the provider even if the patient wants it to be. See "Non-Contracting Provider".

At Risk - Term used to designate financial liability in compensation/reimbursement arrangements. A provider may be "at risk" for additional costs, for example, if the expense of caring for a particular panel of patients exceeds the provider's capitation payment.

Average Wholesale Price -AWP - The usual cost of pharmaceuticals charged to a pharmacy provider by a large group of pharmaceutical wholesale suppliers.

AWP - See "Average Wholesale Price".