Billing, translated
Food
is
Medicine
& Medicaid
billing
terms
defined
Nobody starts a food organization because they love insurance paperwork. Every HRSN, waiver, code, and reimbursement term that shows up in this work — explained in plain English.
All
Programs & Policy
Billing & Reimbursement
Codes & Formats
Payers & Plans
Programs & Policy
Food is Medicine (FIM)
Food is Medicine is the set of clinically targeted nutrition interventions — medically tailored meals, medically tailored groceries, produce prescriptions, and nutrition counseling — paid for by health plans to treat or prevent diet-related disease.
HRSN (Health-Related Social Needs)
HRSN is defined as the social and economic conditions — food insecurity, housing instability, transportation barriers, interpersonal safety — that affect a person's health and that Medicaid increasingly pays to address.
1115 waiver
An 1115 waiver is a federal Medicaid demonstration authority that lets a state test new coverage approaches, including paying community-based organizations for Food is Medicine services that aren't part of traditional Medicaid.
ILOS (In Lieu of Services)
ILOS is a federal Medicaid managed care option that lets a health plan substitute approved non-medical services — like medically tailored meals or housing supports — for traditional medical care when the substitute is cost-effective and medically appropriate.
Social Care Network (SCN)
A Social Care Network is New York's regional hub model for HRSN services under its 1115 waiver. The SCN contracts with Medicaid, manages the CBO network, and bills the state — CBOs invoice the SCN rather than billing Medicaid directly.
CalAIM Community Supports
CalAIM Community Supports is California's Medi-Cal program of 14 approved ILOS services — including medically tailored meals and medically supportive food — that managed care plans contract with CBOs to deliver.
MassHealth Flexible Services
MassHealth Flexible Services is Massachusetts's 1115 waiver program through which accountable care organizations contract with CBOs to provide nutrition and housing supports to eligible Medicaid members.
MCO (Managed Care Organization)
An MCO is a health plan that a state Medicaid program pays a per-member-per-month fee to manage benefits for a defined population. Most Food is Medicine reimbursement is paid by the MCO, not the state directly.
Medicare Advantage supplemental benefits
Medicare Advantage supplemental benefits are non-traditional benefits — including food and meal delivery — that Medicare Advantage plans may offer to enrollees with chronic conditions under CMS's special supplemental benefits for the chronically ill (SSBCI) authority.
Billing & Reimbursement
Eligibility verification
Eligibility verification is the process of confirming a person is enrolled in a specific health plan and covered for a specific benefit before the service is delivered — so claims aren't denied later for coverage reasons.
Claim
A claim is the formal request for payment a provider submits to a health plan for a service rendered to a covered member.
Denial
A denial is a claim a health plan refuses to pay. Denials must be diagnosed, corrected, and resubmitted within the payer's timely-filing window — unworked denials become permanent revenue losses.
Payer enrollment / credentialing
Payer enrollment (or credentialing) is the multi-step approval process by which a provider becomes authorized to bill a specific health plan. It typically takes 60 to 120 days per payer and is required before claims can be submitted.
Provider enrollment
Provider enrollment is registration with a state Medicaid program (and sometimes Medicare) that establishes a CBO or clinical organization as a legitimate billing entity in that state.
Prior authorization
Prior authorization is approval a health plan requires before certain services are delivered. Some Food is Medicine programs require it; others don't, depending on payer and benefit design.
Codes & Formats
837 (Healthcare Claim)
An 837 is the standard electronic file format health plans require for claim submission. 837P (professional) is the format used for most Food is Medicine claims, such as MNT visits. 837I (institutional) is used by facilities such as hospitals and typically does not apply to Food is Medicine billing.
835 (Remittance Advice)
An 835 is the standard electronic file a health plan sends back showing what it actually paid for each submitted claim and the reason for any denials or adjustments.
HRSN Z-codes
HRSN Z-codes are ICD-10-CM codes in the Z55–Z65 range — for example Z59.41 (food insecurity) — that document Health-Related Social Needs on claims and referrals. They're how Food is Medicine programs evidence the social diagnosis driving the service.
HCPCS codes
HCPCS (Healthcare Common Procedure Coding System) codes are the procedure-level identifiers used on claims. Food is Medicine programs increasingly use specific HCPCS codes (and S-codes) to bill for meals, groceries, and nutrition coaching.
CPT codes (for MNT)
CPT codes 97802, 97803, and 97804 are the codes used to bill medical nutrition therapy (MNT) services delivered by a registered dietitian.
NPI (National Provider Identifier)
An NPI is the unique 10-digit identifier the federal government assigns to a healthcare provider. Type 1 NPIs are for individuals (like an RDN); Type 2 NPIs are for organizations.
Payers & Plans
Working capital
Working capital is the cash an organization needs to operate day-to-day — to buy food, pay staff, and load benefit cards — while waiting for slower-paying revenue to arrive.
Working capital advance
A working capital advance pays most of an approved Medicaid claim's value within days of submission, with the balance paid when the health plan settles. It is offered with capital partners and subject to underwriting.
Receivable
A receivable is money a provider has earned but not yet collected. Medicaid receivables typically take 30 to 90 days to collect; denied receivables can stretch 6 to 8 months.
Reconciliation
Reconciliation is the process of matching every payment received from a health plan back to the specific service and claim that earned it, so revenue reports are accurate and unpaid claims surface quickly.
Revenue cycle management (RCM)
Revenue cycle management is the end-to-end set of processes — eligibility, coding, claim submission, denial work, payment posting, reporting — that turns delivered services into collected revenue.
