Code
|
Display
|
Definition
|
coinsurance
|
Coinsurance |
The amount the insured individual pays, as a set percentage of the cost of covered medical services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%. |
noncovered
|
Noncovered |
The portion of the cost of this service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract. |
priorpayerpaid
|
Prior payer paid |
The reduction in the payment amount to reflect the carrier as a secondary payor. |
paidbypatient
|
Paid by patient |
The amount paid by the patient at the point of service. |
paidtopatient
|
Paid to patient |
paid to patient |
paidtoprovider
|
Paid to provider |
The amount paid to the provider. |
memberliability
|
Member liability |
The amount of the member's liability. |
discount
|
Discount |
The amount of the discount |
drugcost
|
Drug cost |
Price paid for the drug excluding mfr or other discounts. It typically is the sum of the following components: ingredient cost, dispensing fee, sales tax, and vaccine administration |