Medical Billing Terms A: AAPC to Age of Majority and Minor Consent (Georgia)

This page defines medical billing terms A for psychotherapists, psychiatrists and the people who bill for them. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms A: Claim adjudication - MCM South Medical Billing Service, LLC

Glossary pages

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Pages in A

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On this page (21 terms)

AAPC
Ability Network
Accountable Care Organization (ACO)
Accountable Care Partnership Plan (ACPP)
Accounting of Disclosures
Accounts Receivable (A/R)
Accreditation
Additional Documentation Request (ADR)
Add-On Code
Adjudication
Administrative Adjustment
Administrative Law Judge (ALJ) Hearing
Administrative Services Only (ASO)
Advance Beneficiary Notice (ABN)
AdvancedMD
Adverse Benefit Determination
Aetna
Age of Majority and Minor Consent: Colorado
Age of Majority and Minor Consent: Connecticut
Age of Majority and Minor Consent: Florida
Age of Majority and Minor Consent: Georgia

How to use these Claim adjudication definitions

Use this page as a quick reference for Claim adjudication, from AAPC to Age of Majority and Minor Consent: Georgia. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm Claim adjudication details with the payer before you bill.

Checklist: put the claim adjudication definitions to work

Check the claim adjudication entries above before you send a claim that depends on them.
Share this claim adjudication page with front-desk and billing staff so everyone works from the same definitions.
When a payer letter mentions claim adjudication, find the matching entry and note the date you checked it.
Keep your claim adjudication notes next to your payer contracts, because a contract can define a term differently.
Ask the payer to confirm in writing how it applies claim adjudication before you change a workflow.
Train new staff on claim adjudication first, then move on to the rest of the glossary.
Log any claim adjudication question that comes up twice, then add the answer to your billing procedures.
Use the source links under the claim adjudication entries to confirm the current rule.
Print the claim adjudication entries you use most and keep them at the billing desk.
Review your claim adjudication notes each quarter, because payer and CMS rules change.
Mark where claim adjudication work differently for psychotherapists and for psychiatrists in your own procedures.

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AAPC

General (all payers)

Also called AAPC; American Academy of Professional Coders

Definition: A professional organization that trains and certifies medical coders and billers.
Why it matters: Coders may hold AAPC credentials, and it publishes coding education.
Illustrative example: A coder holds an AAPC certification.

Related termsCPT Code ICD-10-CM

Reference sourceAAPCchecked 10/9/26

CategoriesClaims Processing

Ability Network

General (all payers)

Also called Ability; Ability clearinghouse

Definition: A health care technology company offering clearinghouse and revenue cycle connectivity. Listed for reference; not an endorsement or partnership.
Why it matters: Appears in payer connection lists.
Illustrative example: A practice connects to a payer through Ability.

Reference sourceAbility Networkchecked 10/9/26

CategoriesEDI & Clearinghouse Terms

Accountable Care Organization (ACO)

General (all payers)

Also called ACO

Definition: A group of providers that voluntarily accepts responsibility for the cost and quality of care for a defined population.
Why it matters: Behavioral health providers may be part of ACO networks with quality and cost targets.
Illustrative example: An ACO shares savings if quality and cost targets are met.

Reference sourceCMS (Centers for Medicare & Medicaid Services)NAACOSchecked 10/9/26

CategoriesValue-Based Care Terminology

Accountable Care Partnership Plan (ACPP)

Medicaid (state-specific)

Also called MassHealth ACPP; ACO plan

Definition: A MassHealth managed care option in which an ACO partners with a health plan to manage care for members.
Why it matters: Behavioral health may be managed within the plan, changing contracts and authorization.
Illustrative example: A MassHealth member is enrolled in an ACPP.

Reference sourceMedicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms Value-Based Care Terminology

Accounting of Disclosures

General (all payers)

Also called HIPAA accounting of disclosures; disclosure log

Definition: An accounting of disclosures is a list of certain disclosures of a patient's protected health information that a patient may request under HIPAA. It generally does not include disclosures for treatment, payment, and health care operations.
Why it matters: Keep a log of disclosures that fall outside routine use, such as certain legally required reports, so you can answer a request.
Illustrative example: A patient asks who received their records outside routine care, and the practice provides its disclosure log.

Reference sourceHHS (U.S. Department of Health and Human Services)HHS Office for Civil Rights (OCR)checked 10/9/26

CategoriesAudits & Compliance

Accounts Receivable (A/R)

General (all payers)

Also called AR; A/R; accounts receivable

Definition: The money owed to a practice for services already delivered, from payers and patients.
Why it matters: A/R age and size show cash flow health.
Illustrative example: A practice has $40,000 in outstanding claims and balances.

Reference sourceHFMAchecked 10/9/26

CategoriesRevenue Cycle Metrics

Accreditation

General (all payers)

Also called organizational accreditation; accredited provider; accrediting body

Definition: Accreditation is a review by an outside organization, such as the Joint Commission, NCQA, or URAC, that finds an organization meets that group's standards.
Why it matters: Payers, states, and funders may require it, and it can help a provider's contract or licensing. It is separate from credentialing of individual clinicians.
Illustrative example: A clinic tells a payer it holds an accreditation to meet a contracting requirement.

Reference sourceThe Joint Commission NCQAchecked 10/9/26

CategoriesQuality & Risk Adjustment Terms Audits & Compliance

Additional Documentation Request (ADR)

General (all payers)

Also called ADR; records request; medical records request

Definition: A payer or contractor's request for records to support a claim before or after payment.
Why it matters: Deadlines are short and non-response usually leads to denial or recoupment.
Illustrative example: A MAC sends an ADR for progress notes and the practice replies on time.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesAudits & Compliance Denials & Appeals

Add-On Code

General (all payers)

Also called add-on code; CPT add-on; plus sign code; +code

Definition: An add-on code is a CPT code, marked with a plus sign, that describes an extra service done together with a primary procedure or service. It is never reported alone.
Why it matters: Examples in behavioral health are +90833, +90836, +90838, +90840, and +90785. Match each add-on to its allowed base codes.
Illustrative example: A psychiatrist bills 99214 as the base and +90833 as the add-on on the same date.

Reference sourceAmerican Medical Association (AMA)CMS Coverage Database, Article A57480 (WPS)checked 10/9/26

CategoriesClaims Processing

Adjudication

General (all payers)

Also called claim adjudication; claim processing

Definition: The payer's process of reviewing a claim and deciding to pay, reduce, deny, or pend it.
Why it matters: Understanding adjudication helps identify where a claim stalled.
Illustrative example: A claim is adjudicated and the payer issues an ERA.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesClaims Processing

Administrative Adjustment

General (all payers)

Also called admin write-off; courtesy adjustment

Definition: A non-contractual adjustment made for administrative reasons, such as small balances or errors.
Why it matters: Requires policy and documentation to avoid waiving cost sharing improperly.
Illustrative example: A practice adjusts a $3 balance under a written policy.

Reference sourceHFMAchecked 10/9/26

CategoriesPayment & Reimbursement Audits & Compliance

Administrative Law Judge (ALJ) Hearing

General (all payers)

Also called ALJ hearing; third-level Medicare appeal

Definition: The third level of the Original Medicare appeal process, a hearing before an administrative law judge, generally subject to a minimum amount in controversy.
Why it matters: Higher levels have thresholds and stricter timelines.
Illustrative example: A provider requests an ALJ hearing after QIC review.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS Medicare Learning Network (MLN)checked 10/9/26

CategoriesDenials & Appeals Medicare & Medicaid Terms

Administrative Services Only (ASO)

General (all payers)

Also called ASO; ASO contract

Definition: A contract in which an insurer or TPA administers a self-funded plan but does not carry the financial risk.
Why it matters: Explains why the same payer can have different rules for different employers.
Illustrative example: A payer's card says 'administered by' rather than 'underwritten by'.

Reference sourceU.S. Department of Labor, EBSAchecked 10/9/26

CategoriesBCBS, UHC & Commercial Payer Terms

Advance Beneficiary Notice (ABN)

Medicare

Also called ABN; CMS-R-131; notice of non-coverage

Definition: A notice a provider gives a Medicare beneficiary before a service that may not be covered, so the patient can decide to receive it and accept financial responsibility.
Why it matters: Without a valid ABN, the provider may not be able to bill the patient for a denied service.
Illustrative example: A provider gives an ABN before a service that may be denied as not medically necessary.

Related termsMedicare Patient Responsibility

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS Medicare Learning Network (MLN)checked 10/9/26

CategoriesMedicare & Medicaid Terms Patient Financial Responsibility Terms

AdvancedMD

General (all payers)

Also called Advanced MD

Definition: A vendor of cloud-based EHR, practice management, and billing software for independent practices. Listed for reference; not an endorsement or partnership.
Why it matters: Used by some small and mid-size practices, including mental health.
Illustrative example: A practice runs scheduling and billing in AdvancedMD.

Reference sourceAdvancedMDchecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Adverse Benefit Determination

General (all payers)

Also called ABD; adverse determination

Definition: A plan decision to deny, reduce, or terminate a benefit or payment, which triggers notice and appeal rights under law.
Why it matters: Starts the clock for appeals and external review.
Illustrative example: A plan denies coverage for a level of care and issues a notice.

Reference sourceU.S. Department of Labor, EBSA CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesDenials & Appeals Audits & Compliance

Aetna

Private payer

Also called Aetna Behavioral Health

Definition: A national health insurer, part of CVS Health.
Why it matters: Has its own network, authorization, and appeal rules.
Illustrative example: A provider checks Aetna's provider portal.

Reference sourceAetnachecked 10/9/26

CategoriesBCBS, UHC & Commercial Payer Terms

Quick answer: Claim adjudication

What does adjudication mean on a claim?

It is the payer's review that ends in pay, reduce, deny, or pend. The result appears on the remittance advice.

Frequently asked questions: Claim adjudication

What is an additional documentation request (ADR)?

A payer or contractor asks for records to support a claim before or after payment. Reply by the deadline in the letter with the notes and forms they name.

What does adjudication mean on a claim?

It is the payer's review that ends in pay, reduce, deny, or pend. The result appears on the remittance advice.

What is the difference between an adverse benefit determination and a denial?

An adverse benefit determination is the formal plan decision to deny, reduce, or end a benefit, and it triggers notice and appeal rights. A claim denial is one common form of it.

Related resources

Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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