Medical Billing Glossary

Comprehensive definitions and explanations of 50+ key medical billing terms: prior authorization, claim denials, CARC codes, modifiers, bundling, adjudication, and more. Written for billers, practice managers, and RCM teams.

• Add-On Code
• Adjudication
• Affiliation
• Age Verification
• Claim Appeal Process
• Authorization Number
• Authorization Penalty
• Balance Billing
• Billing Code Audits
• Bundled Code
• Bundling
• CARC Code
• Case Management
• Clean Claim
• Claim Adjustment
• Claim Denial
• Claim Edits
• Claim Status
• Concurrent Review
• Coordination of Benefits (COB)
• Copay vs Coinsurance
• CPT Code
• CPT Modifier
• Provider Credentialing
• Deductible
• Dependent Coverage
• Downcoding
• Drug Formulary
• Durable Medical Equipment (DME)
• ER Code
• Explanation of Benefits (EOB)
• Fee Schedule
• ICD-10 Code
• In-Network Provider
• Medical Necessity
• Medical Referral
• Modifier Bundle
• Non-Covered Service
• Out-of-Network Provider
• Out-of-Pocket Maximum
• Precertification
• Prior Authorization
• Provider Contract
• Provider Panel
• Remittance Advice
• Remark Code (RARC)
• Retrospective Review
• Retroactive Denial
• Surprise Billing
• Termination of Coverage
• Timely Filing
• Utilization Review

This reference is for informational purposes. Always verify against current payer policies and CMS guidelines. Last updated: 2026-04-06.