Glossary
Outsourcing and billing terms, in plain English
Short, neutral definitions of the terms you meet when you hire an offshore team, a virtual assistant or a BPO partner, or manage a healthcare revenue cycle.
B
BAABusiness associate agreement
A business associate agreement (BAA) is a contract required under HIPAA between a healthcare provider and any outside company that handles patient health information for it, setting out how that information must be protected.
Read moreBPOBusiness process outsourcing
Business process outsourcing (BPO) is hiring an outside company to run a defined business function, such as customer support, billing or data entry, so that the provider manages the people and the process.
Read moreBuild operate transferBuild operate transfer (BOT)
Build operate transfer (BOT) is a model where a partner sets up and runs an offshore office for you, then transfers the team, office and operations to your company.
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C
Captive centerCaptive center or global capability center (GCC)
A captive center is an offshore office that a company owns and runs through its own local legal entity, with the staff employed directly by the company. Larger ones are often called global capability centers (GCCs).
Read moreClaim denial
A claim denial happens when an insurer refuses to pay all or part of a submitted healthcare claim, for reasons such as missing information, coding errors, lack of authorization or ineligible coverage.
Read moreClean claim rate
The clean claim rate, also called the first-pass acceptance rate, is the share of claims that an insurer accepts the first time without needing correction or rework.
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O
Offshore development centerOffshore development center (ODC)
An offshore development center (ODC) is a dedicated team in another country that works only for your company, using your tools and processes, while a local partner handles hiring, office and HR.
Read moreOffshore staffing
Offshore staffing is hiring professionals in another country to work as part of your team, while a local partner handles recruiting, employment, office space and HR.
Read moreOmnichannel support
Omnichannel support connects every customer channel, such as phone, email, chat and social media, so that a customer’s history follows them from one channel to the next.
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P
Prior authorization
Prior authorization is an insurer’s approval, required before certain treatments, tests or medications, confirming that the plan will cover them.
Read moreProvider credentialing
Provider credentialing is the process of verifying a clinician’s qualifications, such as licence, training, work history and malpractice history, so that insurers can confirm they are eligible to treat and bill their members.
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S
SLAService level agreement
A service level agreement (SLA) is a written agreement that sets the measurable standards a service provider must meet, such as response times and accuracy, and what happens if it misses them.
Read moreStaff augmentation
Staff augmentation means adding outside specialists to your existing team on a flexible basis; you manage their daily work, and a partner handles their employment.
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V
Virtual assistant
A virtual assistant is a remote professional who handles administrative, support or operational tasks for a business, such as managing email and calendars, entering data, answering customers or preparing reports.
Read moreVirtual receptionist
A virtual receptionist is a remote person who answers calls, books appointments, takes messages and routes callers for a business, in place of an on-site front desk.
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