Health Insurance 101
Percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible
What is Coinsurance?
This account rolls over from year to year - It's a savings account.
What is HSA?
We should always search by this in MC400 when someone is calling in about a specific claim.
What is Date of Service?
When a spouse is calling in - we need to check if this is on file before we can release any information.
What is PRD?
What is Member Bucket?
UPMC Travel Assistance program.
What is Assist America?
This account is pre-funded by the employer. This is elected during OE and there is a grace period to use the funds.
What is FSA?
IPA 09.
What is Out of Network?
What is 3?
This is the system we use to look up Pharmacy Prior Auths.
What is PA Hub?
Fixed amount for a covered service, paid by a patient to the provider of service before receiving the service - This is usually paid at the time of service
What is Copayment?
This is used for eligible Child Care Expenses.
What is DCA?
What is Totals?
What is Memo Notes?
This is the system we use for all documentation.
What is MC400?
Incentive Program that can be done to lower the members deductible. This can be done every plan year.
The code that is billed for a service that tells us what the procedure is.
What is CPT Code?
Parents cannot view claims on file for members this age and above.
If a member does not have an ID number readily available, we should look the member up in this system.
What is HealthPlaNET?
The document that UPMC Employees uses that tells us what is covered, what is non covered, etc. It's in Infonet.
What is Summary Plan Description?
This account is used for eligible transit or parking expenses.
This code is billed in conjunction with a CPT Code to explain why something was done.
What is Diagnosis Code?
What is PHI?
A premier vision plan covers eye exams every...
What is 12 Months?