Medical and dental billing glossary

Clean claim

A claim accepted by the payer on first submission with no errors or edits.

CPT

Current Procedural Terminology: codes for medical procedures and services.

ICD-10

Diagnosis codes that describe why care was needed.

HCPCS

Codes for supplies, equipment and services not fully covered by CPT.

CDT

Current Dental Terminology: procedure codes for dentistry.

Modifier

A two-character addition to a code that clarifies how a service was performed.

Clearinghouse

An intermediary that checks and routes electronic claims to payers.

ERA / EOB

Electronic remittance advice and explanation of benefits: the payer’s explanation of payment.

Prior authorization

Payer approval required before certain services are delivered.

Denial

A payer’s refusal to pay a claim, usually with a reason code.

A/R

Accounts receivable: money owed to the practice for services already billed.

NPI

National Provider Identifier: a unique ID for healthcare providers in the US.

CAQH

An online database where providers maintain credentialing information for payers.