Health Insurance Software Key Terms

Terms you're likely to encounter in the world of health insurance software
By Lisa Maloney Health insurance software is intended to be the primary interface between the medical provider and the insurance company. Good health insurance management software assists medical billers and coders by compiling and organizing insurance information in a way that can be easily digested by the insurance company. Before you start dealing with health insurance software, you should understand a few key terms that will help you differentiate between types of software and the job roles of those who may be called upon to use the software.
 

Medical coding

Medical coding is the act of transforming a doctor's spoken or written diagnosis into alpha-numeric codes, which are then used for ready access, compilation and categorization of information. A medical coder's job is especially important when dealing with insurance companies. If the wrong codes are put into the medical insurance software, the claim won't make sense to the insurance company and may end up being rejected.
Try: The American Health Information Management Association (AHIMA) offers a brief history and description of medical coding.

Medical biller

The medical biller is typically the person who inputs and submits information into the medical insurance software. The medical billing agent or employee is responsible for aggregating and organizing the information that goes into an insurance form and making sure the proper form is used for each insurance company and insurance claim.
Try: Medical Coding and Billing.com gives an in-depth discussion of a medical biller's duties and job description.

HIPAA

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. This act provides federal protection for personal health information and furnishes patients with certain standardized rights concerning the management of their private information. If the health insurance software you choose doesn't comply with HIPAA, your company won't be in compliance and you could end up in trouble with the feds.
Try: The U.S. Department of Health and Human Services discusses the rights and protections that HIPAA grants.

Conversion

Because different health insurance software companies may use different methods of encrypting or storing client information securely, transferring data from one program to the other without losing any of the encoded details or personal information is a critical need. Conversion is the process whereby one type of medical insurance software retrieves information from another software's encrypted archives and saves it in a new format. In some cases, the medical software can do this unassisted. In other situations you may need the aid of a specialized implementation to help you convert the information.
Try: RAM Technologies explains the process of converting data into their proprietary format, as well as what information must be converted to comply with HIPAA regulations.

Preauthorization, or precertification

Preauthorization, or precertification, is the process by which payment for a certain treatment or medication is authorized by the insurance company before actually being furnished. The best health insurance software should prompt you for preauthorization when appropriate and guide you through the process.
Try: eHealthInsurance explains how and why preauthorization is done. 

Remote access

On-site medical insurance software is installed and hosted on the computers in your office. Remote access software is installed and maintained on computers in the software company's office and allows you to access records from almost anywhere but requires a constant Internet connection and a specialized security configuration.
Try: Group 1 Software details the advantages provided by remote access.