The billable item codes to identify adjudicator specified components to the total billing of a claim.

That portion of the eligible charges which a covered party must pay for each service and/or product. It is a percentage of the eligible amount for the service/product that is typically charged after the covered party has met the policy deductible. This amount represents the covered party's coinsurance that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

That portion of the eligible charges which a covered party must pay for each service and/or product. It is a defined amount per service/product of the eligible amount for the service/product. This amount represents the covered party's copayment that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

That portion of the eligible charges which a covered party must pay in a particular period (e.g. annual) before the benefits are payable by the adjudicator. This amount represents the covered party's deductible that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

The guarantor, who may be the patient, pays the entire charge for a service. Reasons for such action may include: there is no insurance coverage for the service (e.g. cosmetic surgery); the patient wishes to self-pay for the service; or the insurer denies payment for the service due to contractual provisions such as the need for prior authorization.

That total amount of the eligible charges which a covered party must periodically pay for services and/or products prior to the Medicaid program providing any coverage. This amount represents the covered party's spend down that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results

The covered party pays a percentage of the cost of covered services.

The billable item codes to identify modifications to a billable item charge. As for example after hours increase in the office visit fee.

Premium paid on service fees in compensation for practicing outside of normal working hours.

Premium paid on service fees in compensation for practicing in a remote location.

Premium paid on service fees in compensation for practicing at a location other than normal working location.

The billable item codes to identify provider supplied charges or changes to the total billing of a claim.

A charge to compensate the provider when a patient cancels an appointment with insufficient time for the provider to make another appointment with another patient.

A reduction in the amount charged as a percentage of the amount. For example a 5% discount for volume purchase.

A premium on a service fee is requested because, due to extenuating circumstances, the service took an extraordinary amount of time or supplies.

Under agreement between the parties (payor and provider), a guaranteed level of income is established for the provider over a specific, pre-determined period of time. The normal course of business for the provider is submission of fee-for-service claims. Should the fee-for-service income during the specified period of time be less than the agreed to amount, a top-up amount is paid to the provider equal to the difference between the fee-for-service total and the guaranteed income amount for that period of time. The details of the agreement may specify (or not) a requirement for repayment to the payor in the event that the fee-for-service income exceeds the guaranteed amount.

Anticipated or actual final fee associated with treating a patient.

Anticipated or actual initial fee associated with treating a patient.

An increase in the amount charged as a percentage of the amount. For example, 12% markup on product cost.

A charge to compensate the provider when a patient does not show for an appointment.

Anticipated or actual periodic fee associated with treating a patient. For example, expected billing cycle such as monthly, quarterly. The actual period (e.g. monthly, quarterly) is specified in the unit quantity of the Invoice Element.

The amount for a performance bonus that is being requested from a payor for the performance of certain services (childhood immunizations, influenza immunizations, mammograms, pap smears) on a sliding scale. That is, for 90% of childhood immunizations to a maximum of $2200/yr. An invoice is created at the end of the service period (one year) and a code is submitted indicating the percentage achieved and the dollar amount claimed.

A charge is requested because the patient failed to pick up the item and it took an amount of time to return it to stock for future use.

A charge to cover the cost of travel time and/or cost in conjuction with providing a service or product. It may be charged per kilometer or per hour based on the effective agreement.

Premium paid on service fees in compensation for providing an expedited response to an urgent situation.

The billable item codes to identify modifications to a billable item charge by a tax factor applied to the amount. As for example 7% provincial sales tax.

Federal tax on transactions such as the Goods and Services Tax (GST)

Joint Federal/Provincial Sales Tax

Tax levied by the provincial or state jurisdiction such as Provincial Sales Tax