The terms on your remit, defined in plain English.

A/R aging is the breakdown of your outstanding receivables by how old they are (0–30, 31–60, 61–90, 90+ days) — the report that shows where stuck, at-risk money is hiding.

Adjudication is the payer's process of deciding how much to pay on a claim — applying the plan's benefits, contract, edits, and policies to produce the remit.

The allowed amount is the maximum your payer will recognize for a service under the patient's plan — the number every payment, write-off, and patient balance is calculated from.

Appeal levels are the successive stages of disputing a denial — typically two internal levels then an external review for commercial plans, and a fixed five-level ladder for Medicare fee-for-service.

Bundling is when a payer folds one service's payment into another's under NCCI edits (CARC 97); it's recoverable when the services were genuinely separate and the documentation supports a distinct-service modifier.

Buy-and-bill is when a practice purchases a drug, administers it, then bills the payer for it — a high-dollar, high-risk model where a single denial can mean thousands in unrecovered acquisition cost.

A CARC is the standardized code on a remit that tells you why a payer reduced or denied a payment — the single most important field for deciding whether money is recoverable.

A clean claim is one that passes your scrubber and the payer's front-end edits and can be adjudicated without additional information — the input side of a healthy revenue cycle.

A clearinghouse is the intermediary that formats, scrubs, and routes your claims to payers and delivers their remits back — the pipe your 837 claims and 835 remittances travel through.

A contractual adjustment is the difference between your billed charge and the payer's allowed amount that you agree to write off under your contract — normal, unless the allowed amount itself is below your contracted rate.

Coordination of benefits is the rules deciding which plan pays first when a patient has more than one; a stale or wrong COB order (CARC 22, OA) is a common denial that's usually a sequencing fix, not a coverage problem.

Days in A/R is the average number of days it takes to collect your receivables — a speed metric where 30–40 days is healthy and a rising trend signals collection trouble.

Downcoding is when a payer unilaterally reduces a billed code to a lower-paying one — a quiet underpayment that shows up as a reduced payment, not an outright denial.

An EOB is a payer's written explanation of how a claim was processed; on the provider side it's the human-readable remittance that mirrors the data in the 835.

The ERA (electronic remittance advice), transmitted in the X12 835 format, is the electronic explanation of how a payer adjudicated your claim — line by line, with every payment, adjustment, and reason code.

An ERISA plan is an employer-sponsored health plan governed by federal ERISA law rather than state insurance rules — which changes the appeal rights, deadlines, and leverage on a denial.

External review is an independent, outside-the-payer appeal available after internal appeals are exhausted — a real lever on ACA-regulated plans when the payer won't reverse itself.

A fee schedule is the list of contracted rates a payer agrees to pay you per code — the benchmark that turns a payment into a verifiable number and exposes underpayments.

First-pass resolution rate is the share of claims paid on the first submission without any rework — a core efficiency metric where a healthy target is around 90% or better.

A global period is the window after a procedure during which related follow-up care is bundled into the surgical payment; denials of services in that window (CARC 97) are recoverable when the care was unrelated or separately billable with the right modifier.

Group codes are the four X12 codes (CO, PR, OA, PI) that say who is responsible for an adjustment — the first thing to read on a remit because it decides whether you appeal, bill the patient, or write it off.

A J-code is a HCPCS code for a provider-administered drug; getting the J-code, its units, and the NDC right is what stands between a high-dollar drug claim getting paid or denied.

An MUE is a CMS-defined cap on the units of a code allowed per patient per day; units above the cap are denied (CARC 151), and the denied units are recoverable when documentation supports them.

Net collection rate is the percentage of contracted (allowed) dollars you actually collected after legitimate write-offs — the truest measure of whether you're capturing what you earned.

Prior authorization is the payer's requirement to approve a service before you provide it; missing or mismatched auth (CARC 197) is one of the most common denials, and a large share are recoverable.

Prompt-pay laws are state statutes requiring payers to pay clean claims within a set number of days or owe interest — a real lever on slow payment for fully-insured plans.

A RARC is a supplemental code on the remit that adds detail a CARC alone doesn't — often the specific missing element or policy behind a denial.

Recoupment is a payer taking back money it already paid you — often by offsetting it against future payments — after deciding a prior claim was overpaid; the underlying determination is frequently disputable.

Retro-authorization is obtaining a payer's approval for a service after it was delivered — the recovery path for many prior-auth (CARC 197) denials, within the payer's retro window.

The distinction is who bears the claims risk: a fully-insured plan pays a carrier a premium and the carrier owes the claims, while a self-funded employer pays claims from its own funds — which determines whose rules govern a denial.

Sequestration is the mandatory across-the-board reduction to Medicare payments (2% since 2013) applied after adjudication — a legitimate cut, but one worth reconciling so it isn't confused with an underpayment.

A silent PPO is when a payer or network broker applies a contracted discount to your claim without a legitimate contract entitling it to that rate — an unauthorized reduction that's recoverable.

Timely filing is the payer's deadline to submit a claim from the date of service — miss it and the claim is denied (CARC 29), but many of those denials are recoverable with proof of submission.

Upcoding is billing a higher-level or costlier code than the documentation supports — improper and a fraud risk; Volari never does it and only files what the chart substantiates.

Usual, customary, and reasonable (UCR) is the benchmark a plan uses to set allowed amounts for out-of-network care — a payer-defined figure that's often lower and more disputable than a contracted rate.

A write-off is any amount you remove from a claim's balance and stop pursuing — legitimate for true contractual adjustments, but a silent revenue leak when it's applied to money you were actually owed.