Healthcare Glossary¶
Overview¶
This glossary provides definitions for key healthcare, insurance, and technology terms used throughout the BrainSAIT documentation. Terms are presented in English with Arabic translations where applicable.
A¶
Adjudication | تحكيم المطالبات¶
The process by which a payer evaluates a claim to determine payment.
Allowed Amount | المبلغ المسموح¶
The maximum amount a payer will pay for a covered service.
Appeal | استئناف¶
A request for review of a denied claim or authorization.
Authorization | تفويض / موافقة مسبقة¶
Prior approval from a payer for specific services or treatments.
B¶
Benefit | فائدة / تغطية¶
Services or coverage provided under an insurance policy.
Billed Amount | المبلغ المفوتر¶
The total charge submitted by a provider for services.
Bundle | حزمة¶
A collection of FHIR resources submitted together.
C¶
CCHI | مجلس الضمان الصحي التعاوني¶
Council of Cooperative Health Insurance - Saudi insurance regulator.
Claim | مطالبة¶
A request for payment submitted to a payer for healthcare services.
Clearinghouse | غرفة مقاصة¶
An intermediary that processes and routes claims between providers and payers.
Coinsurance | التأمين المشترك¶
The percentage of costs a patient pays after the deductible.
Copay | الدفع المشترك¶
A fixed amount paid by a patient at the time of service.
Coverage | تغطية¶
Insurance benefits provided under a health plan.
CPT | التصنيف الإجرائي الحالي¶
Current Procedural Terminology - codes for medical procedures.
D¶
Deductible | الخصم¶
Amount a patient pays before insurance begins paying.
Denial | رفض¶
A claim rejected by a payer and not paid.
DOS | تاريخ الخدمة¶
Date of Service - when healthcare services were provided.
E¶
EDI | تبادل البيانات الإلكتروني¶
Electronic Data Interchange - standard format for electronic transactions.
Eligibility | الأهلية¶
A patient's qualification for insurance coverage.
EOB | شرح المنافع¶
Explanation of Benefits - statement from payer about claim processing.
ERA | تحويل الإرسال الإلكتروني¶
Electronic Remittance Advice - electronic payment explanation.
F¶
FHIR | موارد التشغيل البيني السريع للرعاية الصحية¶
Fast Healthcare Interoperability Resources - healthcare data exchange standard.
First-Pass Rate | معدل القبول الأول¶
Percentage of claims accepted on first submission.
G¶
GlobeMed | جلوب ميد¶
Third-party administrator operating in Saudi Arabia.
H¶
HCPCS | نظام ترميز الإجراءات المشتركة للرعاية الصحية¶
Healthcare Common Procedure Coding System.
HIM | إدارة المعلومات الصحية¶
Health Information Management.
HIS | نظام معلومات المستشفى¶
Hospital Information System.
HL7 | المستوى الصحي السابع¶
Health Level Seven - healthcare interoperability standards organization.
I¶
ICD-10 | التصنيف الدولي للأمراض¶
International Classification of Diseases, 10th Revision - diagnosis codes.
ICD-10-AM | التصنيف الدولي للأمراض - النسخة الأسترالية المعدلة¶
Australian Modification of ICD-10 used in Saudi Arabia.
L¶
LOA | خطاب الموافقة¶
Letter of Approval - authorization document from payer.
LOS | مدة الإقامة¶
Length of Stay - duration of hospital admission.
M¶
Medical Necessity | الضرورة الطبية¶
Clinical appropriateness and need for a service.
Member ID | رقم العضوية¶
Unique identifier for an insured patient.
MOH | وزارة الصحة¶
Ministry of Health - Saudi Arabia.
N¶
NCD | تغطية القرار الوطني¶
National Coverage Determination.
Network | الشبكة¶
Providers contracted with a payer.
NPI | معرف مقدم الخدمة الوطني¶
National Provider Identifier.
NPHIES | منصة الصحة الوطنية لتبادل المعلومات¶
National Platform for Health Information Exchange - Saudi national health exchange.
O¶
OON | خارج الشبكة¶
Out-of-Network - providers not contracted with a payer.
OOP | الدفع من الجيب¶
Out-of-Pocket - patient's direct payment responsibility.
P¶
Payer | الدافع / شركة التأمين¶
Insurance company or organization responsible for payment.
PCP | طبيب الرعاية الأولية¶
Primary Care Physician.
PDPL | نظام حماية البيانات الشخصية¶
Personal Data Protection Law - Saudi data protection regulation.
PHI | المعلومات الصحية المحمية¶
Protected Health Information.
Prior Auth | الموافقة المسبقة¶
Prior Authorization - advance approval for services.
R¶
RCM | إدارة دورة الإيرادات¶
Revenue Cycle Management.
Rejection | رفض¶
A claim returned due to errors requiring correction.
Remittance | تحويل الدفع¶
Payment and explanation sent from payer to provider.
S¶
SNOMED CT | التسمية الطبية المنهجية¶
Systematized Nomenclature of Medicine - clinical terminology.
SOP | إجراء التشغيل القياسي¶
Standard Operating Procedure.
T¶
Timely Filing | التقديم في الوقت المحدد¶
Deadline for submitting claims to a payer.
TPA | مسؤول طرف ثالث¶
Third-Party Administrator - organization that processes claims for insurers.
U¶
UCR | المعتاد والعرفي والمعقول¶
Usual, Customary, and Reasonable - charge evaluation method.
UM | إدارة الاستخدام¶
Utilization Management - oversight of healthcare service use.
UR | مراجعة الاستخدام¶
Utilization Review - evaluation of medical necessity.
V¶
Verification | التحقق¶
Process of confirming patient eligibility and benefits.
W¶
Write-off | شطب¶
Amount removed from patient responsibility, not collectible.
Related Documents¶
Last updated: January 2025