Glossary

A working vocabulary for the platform's billing surface. Terms link to the chapter where they're used in context.

A

• 837P / 837I — X12 claim transactions. P for professional (CMS-1500), I for institutional (UB-04). See 3.6.
• 835 — X12 electronic remittance advice. The payer's "here is what we paid" file. See 4.1.
• 270 / 271 — eligibility inquiry / response. See 2.4.
• 276 / 277 — claim status inquiry / response. See 6.4.
• 278 — authorization request / response. See 2.5.
• 999 — functional acknowledgment of an EDI file. See 3.2.
• 277CA — claim acknowledgment with payer-side accept/reject. See 3.2.
• AR — Accounts Receivable. Total open claim + patient balance.
• Auto-correction — engine that fixes common denials and rebuilds. See 5.3.

B

• Bill type — 4-digit code on UB-04 / 837I CLM05-1 identifying facility / claim type.
• Bundle / bundling — combining services per CCI rules.
• BPR — 835 segment carrying total payment.

C

• CARC — Claim Adjustment Reason Code on 835 CAS segment. See 5.2.
• CAS — adjustment segment in 835 carrying CARC + amount.
• CCI — Correct Coding Initiative; bundling rules.
• Charge — billable service event from the EMR. See 2.1.
• Claim — one or more charges packaged for submission to a payer.
• Clearinghouse — third party that aggregates and routes claims.
• COB — Coordination of Benefits. The order of payers. See 3.5.
• Companion guide — a payer's specific X12 implementation rules.

D

• DAR — Days in AR. See 6.2.
• Denial — payer's negative adjudication (or any CO adjustment category). See 5.1.
• DOS — Date of Service.

E

• EDI — Electronic Data Interchange. X12 is the EDI standard.
• Eligibility — coverage validity for a member on a DOS. See 2.4.
• ERA — Electronic Remittance Advice. Same as 835.
• EOB — Explanation of Benefits. The human-readable cousin of an ERA.

F

• Fee schedule — payer's contracted rates per procedure.
• Filing type — Professional (P) or Institutional (I).
• Frequency code — 1 original, 7 replacement, 8 void on 837 CLM05-3.

I

• ICN — Internal Control Number. The trading partner's transaction identifier.
• Idempotency — a property where running the same operation twice has the same effect as running it once. The auto-correction engine uses partial-unique constraints to enforce idempotency on (denial_id, handler_name).

L

• LOA — Leave of Absence. Tracked via OCC-74 on 837I.
• LCD — Local Coverage Determination. Some payers reference these in denials.

M

• MUE — Medically Unlikely Edit. Per-procedure unit cap.
• MSP — Medicare Secondary Payer. The matrix governing when Medicare is primary vs secondary.

N

• NPI — National Provider Identifier. 10-digit, with checksum.

P

• Payer — the insurance company / Medicaid / Medicare entity that pays.
• PHI — Protected Health Information.
• PLB — Provider-Level adjustment on 835 footer.
• POS — Place of Service code on professional claims.
• PR — Patient Responsibility CAS group; routes to patient AR.

R

• RARC — Remittance Advice Remark Code on 835 LQ segment. See 5.2.
• Rebill — re-submission of a claim under a new claim ID with parent_claim_id set.
• Receivable — an incoming 835 awaiting posting. See 4.1.
• Replacement — frequency-7 corrected claim. See 3.4.

S

• Scrubber — pre-submit checks (modifier injection, validation, bundling, pricing).
• SVC — service-line segment in 835.
• STC — status segment in 277CA / 277.

T

• TFD — Timely Filing Days; payer's filing window. See 6.3.
• Trading partner — the entity that delivers / receives EDI files for a given payer.
• Trace — the receivable tab showing raw X12 segments and their UI mapping. See 4.7.

V

• Variance — difference between expected and posted on a claim line. See 4.6.
• Void — frequency-8 cancellation. See 3.4.

W

• Waterfall (COB) — the algorithm that pushes residual liability down the payer ladder. See 3.5.
• Write-off — discretionary balance reduction with reason. See 5.6.

RBAC scope decoder

Scope prefix	Domain
billing.charge.*	Charges.
billing.claim.*	Claims.
billing.denial.*	Denials and appeals.
billing.receivable.*	Receivables / 835 posting.
billing.payment.*	Payments / write-offs.
billing.cob.*	COB chain.
billing.adjustment.*	Manual adjustments.
billing.statements.*	Patient statements.
billing.auto-correction.*	Engine triggering and overrides.
billing.claim-status.*	276 / 277 inquiry.
clinical.authorization.*	Auth view / write / request.
eligibility.*	Eligibility refresh.
member.*	Member records.
reports.read.*	Reporting widgets.
report.export	CSV / PDF export.
audit.read	Audit log.