# Glossary

This glossary is for developers who are new to benefits administration, to VBA, or to both. Each entry gives a short definition, the field or schema where the term appears in the API, and the page that uses it.

Definitions come from the field descriptions in the [API reference](/openapi/vbasoftware/vbasoftware.api) and from the API's own behavior. They are pending review by a VBA subject-matter expert.

## Organizations and plans

| Term | Definition | Key field | See |
|  --- | --- | --- | --- |
| **TPA** | A third-party administrator: a company that runs benefit plans (enrollment, claims, billing) on behalf of employers or insurers. VBA's clients are typically TPAs. |  | [Welcome](/developer-portal/get-started/overview) |
| **Group** | The employer or other organization whose members are covered; it carries settings such as its billing cycle and payor. | `Groups.group_ID` | [Onboard a new employer group](/developer-portal/playbooks/onboard-employer-group) |
| **Division** | A subdivision of a group (for example a location or class of employees); its ID is unique only within its group. | `GroupDivision.division_ID` | [Data model](/developer-portal/concepts/data-model) |
| **Group contract** | The coverage period for a group and division, starting on its coverage start date. | `GroupContract` (`group_ID`, `division_ID`, `coverage_Start`) | [Data model](/developer-portal/concepts/data-model) |
| **Group coverage start** | The start date of the group contract that an enrollment belongs to; it is part of the key of every enrollment record. | `SubEnrollment.group_Coverage_Start` | [Disenroll a member or group](/developer-portal/playbooks/disenroll-member) |
| **Plan** | A benefit plan that a group offers and members enroll in. | `Plans.plan_ID` | [Enroll employees](/developer-portal/playbooks/enroll-employees) |
| **Plan type** | The kind of plan, such as medical or dental. Accumulators are tracked by plan type, not by individual plan. | `Plans.plan_Type`, `PlanType` | [Data model](/developer-portal/concepts/data-model) |
| **Plan year** | A named accumulator period for a group and division, for example `CY2030` for calendar year 2030. | `GroupPlanYear.plan_Year` | [Data model](/developer-portal/concepts/data-model) |
| **Benefit** | A covered service category within a plan, identified by a benefit code; plan benefits set how each is paid. | `BenefitCodes.benefit_Code`, `PlanBenefits` | [`GET /benefits`](/openapi/vbasoftware/vbasoftware.api/benefits/listbenefits) |
| **Billing cycle** | The schedule a group is invoiced on; it is used when premium invoices are created. | `Groups.billing_Cycle_ID` | [Bill premiums and apply payments](/developer-portal/playbooks/premium-billing-and-payments) |
| **Payor** | The individual or institution responsible for paying claims; each group is associated with a payor. | `Payor.payor_ID`, `Groups.payor_ID` | [`GET /payors`](/openapi/vbasoftware/vbasoftware.api/payor/listpayor) |
| **Payee** | The individual or institution that receives payment; checks are made out to the payee's name. | `Payee.payee_ID` | [`GET /payees`](/openapi/vbasoftware/vbasoftware.api/payees/listpayee) |
| **Provider** | A doctor, facility, or other source of care. VBA identifies providers by its internal `provider_ID`, not by NPI. | `Provider.provider_ID` | [Create an authorization](/developer-portal/playbooks/create-authorization) |
| **Network** | A set of providers with agreed terms; claims can be paid differently in and out of network. | `Networks.networkID` | [`GET /networks`](/openapi/vbasoftware/vbasoftware.api/networks/listnetworks) |


## People and enrollment

| Term | Definition | Key field | See |
|  --- | --- | --- | --- |
| **Subscriber** | The family unit in VBA, headed by the insured (usually the employee). | `Subscribers.subscriber_ID` | [IDs, keys and field names](/developer-portal/concepts/ids-and-conventions) |
| **Member** | One covered person in a subscriber's family: the insured, a spouse, a dependent, or another relation. | `Members` (`subscriber_ID`, `member_Seq`) | [Member self-service](/developer-portal/playbooks/member-self-service) |
| **Member sequence (`member_Seq`)** | The two-character number of a member within the family; together with `subscriber_ID` it identifies the member. | `member_Seq` | [IDs, keys and field names](/developer-portal/concepts/ids-and-conventions) |
| **Insured** | The member who is the subscriber; requests such as disenrollment have a `subscriber` flag that is `true` only for this member. | `EnrollmentDisenroll.subscriber` | [Disenroll a member or group](/developer-portal/playbooks/disenroll-member) |
| **Dependent** | A member other than the insured, such as a spouse or child; the relationship is recorded on the member. | `Members.relationship` | [Enroll employees](/developer-portal/playbooks/enroll-employees) |
| **Enrollment (`SubEnrollment`)** | A subscriber's coverage under one group contract, with its own start and end dates; plan elections hang off it. | `SubEnrollment` (`subscriber_ID`, `group_ID`, `division_ID`, `group_Coverage_Start`, `start_Date`) | [Enroll employees](/developer-portal/playbooks/enroll-employees) |
| **Start date** | The date an enrollment's coverage starts, as distinct from the group coverage start of the contract it belongs to. | `SubEnrollment.start_Date` | [Disenroll a member or group](/developer-portal/playbooks/disenroll-member) |
| **Plan enrollment** | A subscriber's or member's election of a plan within an enrollment, with plan start and end dates. | `SubEnrollmentPlan`, `MemEnrollmentPlan` | [Extract data with the Search API](/developer-portal/playbooks/search-extract) |
| **Disenrollment** | Ending a member's, family's, group's, or division's coverage as of a disenroll date; it can also end future enrollments and cancel authorizations. | `EnrollmentDisenroll`, `Members.disenroll_Date` | [Disenroll a member or group](/developer-portal/playbooks/disenroll-member) |
| **Reason** | A configured reason for an enrollment change, either a standard reason or a COBRA qualifying event. | `Reasons.reason_ID`, `reason_Type` | [Disenroll a member or group](/developer-portal/playbooks/disenroll-member) |
| **COBRA** | Continuation of coverage after a qualifying event such as leaving employment; a group setting says whether the group administers COBRA. | `Groups.admin_COBRA`, `EnrollmentDisenroll.premRates` | [Disenroll a member or group](/developer-portal/playbooks/disenroll-member) |
| **ID card request** | A request to produce a member ID card. | `IDCardRequest.idCardRequest_Key` | [`POST /id-card-requests`](/openapi/vbasoftware/vbasoftware.api/member-id-card-requests/createidcardrequest) |


## Claims

| Term | Definition | Key field | See |
|  --- | --- | --- | --- |
| **Claim batch** | A container for claims that have been entered but not yet processed. | `ClaimBatches.batch_Number` | [Enter claims and adjudicate them](/developer-portal/playbooks/claims-intake-and-adjudication) |
| **Batch claim** | One claim inside a claim batch, identified by its batch number and batch claim number. | `ClaimBatch` (`batch_Number`, `batch_Claim`) | [Enter claims and adjudicate them](/developer-portal/playbooks/claims-intake-and-adjudication) |
| **Service line (claim detail)** | One service on a claim, with its procedure code and amounts. | `ClaimBatchDetail` (`claim_Seq`, `adjustment_Seq`) | [Enter claims and adjudicate them](/developer-portal/playbooks/claims-intake-and-adjudication) |
| **Adjudicate** | Apply the plan's benefit rules to a claim in a claim batch to work out what is paid. The claim stays in the claim batch. |  | [`POST .../adjudicate`](/openapi/vbasoftware/vbasoftware.api/claim-adjudication/adjudicateclaim) |
| **Process** | Adjudicate a claim and, if no business rule stops it, move it out of the claim batch into the processed claims (`Claim`). | `Claim.claim_Number` | [`POST .../process`](/openapi/vbasoftware/vbasoftware.api/claim-adjudication/processclaim) |
| **Pend** | Hold a claim for review instead of finalizing it; a pended claim is not moved out of the claim batch when it is processed. |  | [Enter claims and adjudicate them](/developer-portal/playbooks/claims-intake-and-adjudication) |
| **Claim queue** | A set of claims that are adjudicated or processed together in the background. | `ClaimQueue.claimQueue_Key` | [`POST /claim-queues/{claimQueueKey}/process`](/openapi/vbasoftware/vbasoftware.api/claim-adjudication/processclaimqueue) |
| **Explanation code (ex code)** | A reason code on a claim or service line, assigned by a user or by adjudication. | `ClaimBatchDetail.ex_Code`, `ExplanationCodes.ex_Code` | [Enter claims and adjudicate them](/developer-portal/playbooks/claims-intake-and-adjudication) |
| **EOB** | Explanation of benefits: the statement that tells a member how a processed claim was paid. |  | [`GET /claims/{claimNumber}/eob`](/openapi/vbasoftware/vbasoftware.api/eob/getmembereob) |
| **Accumulator** | A running total, per member, plan type, and plan year, of amounts such as deductible and out-of-pocket used. | `MemberAccum` | [Member self-service](/developer-portal/playbooks/member-self-service) |
| **Deductible** | The amount a member pays before the plan starts to pay; the amount used so far is accumulated. | `MemberAccum.deductible_Used` | [Member self-service](/developer-portal/playbooks/member-self-service) |
| **Out-of-pocket maximum** | The most a member pays in a plan year; the amount used so far is accumulated. | `MemberAccum.out_Of_Pocket` | [Member self-service](/developer-portal/playbooks/member-self-service) |
| **Authorization (auth)** | Prior approval for a member to receive specific services from a provider, which claims are later matched against. | `Auth.auth_Number` | [Create an authorization](/developer-portal/playbooks/create-authorization) |
| **Auth code** | A configured status for an authorization; each has an action such as approved, denied, pended, or voided. | `AuthCode.auth_Code`, `auth_Action` | [Create an authorization](/developer-portal/playbooks/create-authorization) |


## Billing

| Term | Definition | Key field | See |
|  --- | --- | --- | --- |
| **Premium** | The amount charged for coverage, billed on premium invoices. |  | [Bill premiums and apply payments](/developer-portal/playbooks/premium-billing-and-payments) |
| **Premium invoice** | A bill for premiums for a billing period; once finalized it cannot be changed. | `PremInvoice.invoice_Key`, `finalized` | [Bill premiums and apply payments](/developer-portal/playbooks/premium-billing-and-payments) |
| **Premium payment** | A payment received against premiums, which is then applied to invoices. | `PremPayment.premPayment_Key` | [Bill premiums and apply payments](/developer-portal/playbooks/premium-billing-and-payments) |


## API terms

| Term | Definition | Key field | See |
|  --- | --- | --- | --- |
| **SearchConfig** | A named set of tables and columns that the Search API can query together, such as `ENROLLMENT` or `CLAIM`. | `SearchConfig.id` | [SearchConfig reference](/developer-portal/reference/search-config-reference) |
| **Criteria** | The saved filter a search applies, made of criteria details (table, column, operator, values). | `Criteria.criteria_Key` | [Search API](/developer-portal/concepts/search) |
| **VBAProcess** | A record of a long-running VBA process, such as a disenrollment, with its start, end, and result. | `VBAProcess.vbaProcess_Key` | [Disenroll a member or group](/developer-portal/playbooks/disenroll-member) |
| **activityID** | The identifier of a request in VBA's logs, returned in every response envelope; include it when you contact support. | `debug.activityID` | [Requests and responses](/developer-portal/concepts/requests-and-responses) |
| **ID token** | The token from `POST /user-authentication` that you send as `Authorization: Bearer <idToken>`. | `authenticationResult.idToken` | [Authentication and tokens](/developer-portal/concepts/authentication) |
| **Database** | The VBA database a request works in, chosen with the `vbasoftware-database` header. | `vbasoftware-database` | [Credentials and environments](/developer-portal/get-started/credentials-and-environments) |