This post is another article in our series on medical billing and coding terminology. Today, we will be discussing the most important industry terms that you should that begin with the letter T. While we know it can seem a little daunting when we throw all of these important terms at you at once, it is important for you to familiarize yourself with all of them. Keeping all of these terms straight can be frustrating, especially when you know a mistake can lead to a claim being unpaid, but simply exposing yourself to the definitions once or twice can help a lot, so don’t lose faith.
Taxonomy Code –
Standardized codes used to indicate a doctor or care provider's specialty. These are not required in all cases but are needed in some cases to ensure payment.
Technical Component –
The technical aspect of a procedure, which does not include interpretation of the data gathered. For example, it might refer to the CAT scan but not the neurologist's time and expertise in reviewing the data and consulting with the patient or other doctors.
Term Date –
This is seen most often as the date a subscriber is no longer covered by the insurance. It can also apply to the date that the provider's contract with the insurance expires.
Tertiary Insurance Claim –
Primary insurance pays first. Secondary insurance is billed for items or services not covered by the first insurance. For some patients, there is a tertiary insurance that can be billed for items or services not covered by the first two but are covered by the third insurance.
Third Party Administrator (TPA) –
A self-insured company or organization typically has an independent corporate entity to administer their benefits and claims. This is done to prevent bias and fraud.
Tax Identification Number (TIN) –
This is the number a business uses to identify itself in paying taxes, receiving payments, and paying others. Sometimes it is also called the Employer Identification Number (EIN)
Treatment Authorization Request (TAR) –
A treatment authorization request is almost always needed for inpatient hospital stays and often for other procedures as well. Each insurance company has their own process for reviewing these requests and giving a decision in a timely manner. If the initial decision is not to authorize, an appeal can be filed. In most cases, if the authorization is not on file, the insurance will no pay a claim even if the service would otherwise have been covered.
Triple Option Plan (TOP) –
This is sometimes referred to as a cafeteria plan. The patient/insured is given a choice by the company about what type of insurance options they desire. This can include: HMO, PPO, traditional insurance, or even a HSA and a variety of available deductibles.
Type of Service (TOS) –
A category on the billing form. It should include the type of service performed, for example, a surgery.
This is a federal health insurance plan. People who may have TRICARE include active duty military, retirees, and national guard. This can often include their spouse, children, or survivors.
For assistance with your medical billing needs, please feel free to contact us at any time. Let us handle the headaches caused by trying to keep everything straight, and you can just sit back and collect the payments.