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Glossary

Advance Beneficiary Notice (ABN)

A notice given by a provider or supplier to a patient; typically used to inform the patient that Medicare will not cover a service, and the patient must, therefore, assume financial responsibility for the service if he/she wishes to receive it. [41]

Claim

A request for payment for services and benefits that a patient received. [41]

Covered Benefit

A health service or item fully or partially paid for by an insurer. [41]

CPT Code

Current Procedural Terminology coding system used to classify treatment or physician services in numeric form on a claim. [41]

Explanation of Benefits (EOB)

The summary of insurer coverage for a medical service provided. [42]

ICD-10-CM

The International Classification of Disease, 10th Revision, Clinical Modification coding system used to classify diagnoses and morbidity factors. [41]

National Drug Code (NDC)

A medical code established and maintained by the Food and Drug Administration (FDA) for approved
drugs. [41]

Non-covered Service

A medical service that does not meet the requirements or is excluded from coverage. [41]

Patient Financial Responsibility Agreement (PFRA) Form

A form signed by the patient stating that he/she is responsible for services not covered by the insurance company. [43, 44]

Remittance Advice (RA)

A notice that explains the reasons for payments and adjustments of processed claims. [45]

Please note that this website is provided for informational purposes only and is not intended to serve as comprehensive training on medical billing and coding. Additional training on medical coding may be required. The information on this website is believed to be accurate as of the date of publication. Users should independently verify accuracy.

Healthcare providers are responsible for making the ultimate decision on when to use a specific product based on clinical recommendations and how to bill for products and related services rendered. Consult third-party insurers' guidelines for specific information regarding the billing and reporting of services rendered.

1010431R0 October 2018

You are encouraged to report vaccine adverse events to the US Department of Health and Human Services.
Visit www.vaers.hhs.gov to file a report, or call 1-800-822-7967.

To learn more about the
GSK Vaccines Access Program,
click here.
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