Plain terms
Medicaid doula billing glossary
Simple definitions for doulas who want the billing words translated into everyday language.
Billing words in plain language
Claim packet
The set of details a doula or biller reviews before a claim is entered. It can include setup, eligibility, service details, notes, and review status.
Provider setup
The state, payer, portal, and business records a doula needs before billing can work cleanly.
Client eligibility
A private check that the client has coverage for the date and type of care you plan to bill.
Service details
The date, type of support, code, modifier, time, units, and rate information connected to a visit or birth.
Modifier
A short code added to a billing code when the payer needs more detail about the service.
Units
How some payers count time or visits. For example, one unit may mean 15 minutes in some state rules.
Prior approval
Permission that may be needed before some services can be paid. The exact rule depends on the state or payer.
Denial
A payer response saying a claim was not accepted or paid as submitted. The reason should guide the next step.
Payment tracking
Keeping track of what was billed, what was paid, what was denied, and what still needs follow-up.
Use the words in context
These pages show how the terms fit into real Medicaid doula billing steps.