Workflow Mastery
Commercial Product Terminology
Custom Products
Health Insurance Terms
Ancillary Benefits
100
You use this subject/category to document looking for a PCP
What is Channeling/ PCP
100
A company that has their insurance through Lovelace Health Plan/Lovelace Insurance Company
What is Group
100
Lovelace assumes the risk
What is Fully Insured
100
A person who has obtained health insurance coverage under a health insurance plan
What is Insured
100
This group manages our RX riders
What is Lovelace
200
You use this subject/category to document all eligibility calls
What is Eligibility/Eligibility Inquiry
200
Any Subscriber or Dependent who elects the Plan coverage and for whom the required Premium has been received by the Plan
What is Member
200
Also referred to as administrator services
What is Self Insured
200
The written contract between an individual or group policyholder and an insurance company
What is Policy
200
There are this many RX riders
What is 22
300
A provider has questions regarding their portal access; you would use this subject/category to document this call
What is Provider/Provider Portal- Other
300
Lovelace Health Plan
What is LHP
300
If we do not make these standards we will be fined
What is Performance Guarantee
300
Insurance companies and hospitals watch their costs and quality by having medical personnel review selected medical cases
What is Utilization Review
300
This group handles our dental plans
What is United Concordia
400
You use this subject/category to document prescription co-pays
What is Pharmacy/Co-Pay/Fin Responsibility
400
Health Maintenance Organization
What is HMO
400
This group is our largest ASO group
What is UNM
400
A physician’s office visit which is not prompted by sickness or injury
What is Wellness Office Visit
400
This group handles our COBRA benefits
What is OptumHealth
500
You use this subject/category to document prior authorization questions
What is UM History/ Prior Authorization Verification
500
Preferred Provider Organization
What is PPO
500
This makes a shelf product custom
What is One change
500
The money you pay for health insurance
What is Premium
500
This group offers assistance more than 100 miles from home
What is Assist America
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