The total submitted amount for the claim or group or line item.

Patient Co-Payment

Amount of the change which is considered for adjudication.

Amount deducted from the eligible amount prior to adjudication.

Amount payable under the coverage

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%.

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.

The reduction in the payment amount to reflect the carrier as a secondary payer.

The total amount paid by the patient without specifying the source.

The amount paid by the patient using cash, check, or other personal account.

The amount paid by the patient using a method different than cash (cash, check, or personal account) or health account.

paid to patient

The amount paid to the provider.

The amount of the member's liability.

The amount of the discount

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

defines the adjudication slice to define allowed units

Defines the adjudication slice to identify the adjustment reason

Defines the adjudication slice to identify the reject reason

Indicates the Billing Provider network status in relation to a patient's coverage as of the effective date of service or admission.

Indicates the Rendering Provider network status in relation to a patient's coverage as of the effective date of service or admission.

Indicates the network payment status in relation to a patient's coverage as of the effective date of service or admission.