Which term describes the maximum reimbursement calculated from the payer's remittance and your contract?

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Multiple Choice

Which term describes the maximum reimbursement calculated from the payer's remittance and your contract?

The concept here is the Allowed Amount. This is the negotiated maximum reimbursement between the insurer and the provider, the amount the payer agrees to pay for a service under the contract. The payer’s remittance lists this allowed amount, and any provider charges above it are adjusted down (contractual write-offs). This allowed amount is used to determine how much the payer pays and, after applying deductible, copays, and coinsurance, how much the patient is responsible for. Denied or non-covered amounts would fall under Not Allowed Amount, and the actual payment from the payer is the Paid Amount, while the remaining balance after applying the allowed amount and patient cost share becomes Patient Responsibility.

The concept here is the Allowed Amount. This is the negotiated maximum reimbursement between the insurer and the provider, the amount the payer agrees to pay for a service under the contract. The payer’s remittance lists this allowed amount, and any provider charges above it are adjusted down (contractual write-offs). This allowed amount is used to determine how much the payer pays and, after applying deductible, copays, and coinsurance, how much the patient is responsible for. Denied or non-covered amounts would fall under Not Allowed Amount, and the actual payment from the payer is the Paid Amount, while the remaining balance after applying the allowed amount and patient cost share becomes Patient Responsibility.

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