TERMS 1
It is a United states Tax processing number issued by the Internal Revenue Service; It is a 9 digit number.
What is Taxpayer Identification Number?
A record of medical services provided to a patient and submitted by the provider to the insurance company for payment/request filled by the provider to get payment.
What is a claim?
IDs used to search for a member in ESAWS
What are
CIN Number (for Medicaid members)
New Member ID (NMI)
Social Security Number
HIX Number
Does not cover IVF, GIFT, ZIFT, FET or more complex infertility treatments.
What is Infertility Mandate?
A medical condition in which the heart is enlarged. It is more commonly referred to as an enlarged heart
What is Cardiomegaly?
The tendency of people who have a greater-than-average likelihood of loss to apply for
or continue insurance protection to a greater extent than people who have an average or
less-than-average likelihood of the same loss.
What is Anti-selection?
Collates the statistical data based on age, gender, demographic location and evaluate the minimum and maximum premium.
What is an actuary?
When clicked a screen will pull up where the rider list for that contract as well access a summary document highlighting benefits can be viewed
What is CAT#? or What is spyglass beside CAT#?
Prohibit insurers and HMOs from limiting a woman’s direct access to primary or preventative services or pregnancy related care from a qualified network provider of her choice to less than two examinations per year for most insured groups. Likewise, insurers and HMOs may not limit direct access to follow-up care or treatment that becomes necessary as a result of such examinations or as a result of an acute gynecological condition. |
What is Women’s Preventive Services (WPS) Mandate or Well Woman Mandate?
A medical practitioner qualified to diagnose and treat tumors
What is an Oncologist?
An amount which has to be spent by the insured before the insurer starts covering the medical expenses of the individual.
What is a deductible?
An amount fixed by the insurance company which the member has to pay at the time of service.
What is a co-payment?
This detailed information can be displayed as form view or list view which displays as a single line of data. Provides a snapshot of the Member including full name & address, DOB, PCP, etc.
Buttons at the top of the grid are for Request and Reference Options
The spyglasses, when clicked, will provide additional information (if applicable)
Alerts may appear, providing additional information
What is Member Demographics?
Requires HMO’s and indemnity carriers to provide a minimum of 30 inpatient mental health days and 20 outpatient mental health visits and mandates unlimited inpatient, partial hospitalization and outpatient mental health coverage for large group policyholders for treatment of specific Mental Health biologically based diagnoses and Children with Serious Emotional Disturbances (SED). |
What is Timothy's Law? or What is Mental Health Parity Law?
An enhanced form of x-ray technology that is used to measure bone loss.
What is a DEXA Scan? or What is a dual energy X-ray absorptiometry scan?
A probability or threat of damage, injury, liability, loss, or other negative occurrence that is caused by external or internal factors.
What is Risk?
A process by which an insurer uses information about a plan member’s health status,
personal and family health related behaviors to predict the member’s likelihood of
experiencing specific illness or injuries.
What is Health risk assessment?
Display any alert that has been setup for the member. Alert Types maybe: Domestic Issues; Identity/ Eligibility issues; Mailing Issues; PCP restrictions; or Member Password Verification.
What is Patient Alerts?
Establishes regulations around a dispute resolution process that holds the members harmless for costs associated with non-emergency services, unexpected bills from non-par providers or "surprise bills"
What is Out of Network (OON) Bill?
The administration of antigenic material to stimulate an individual's immune system to develop adaptive immunity to a pathogen.
What is Vaccination?
A contract between two parties whereby one party
agrees to undertake the risk of another in exchange for consideration known as premium or promises to pay a fixed sum of money to the party on
happening of an uncertain event.
What is an Insurance?
This act helps ensure that privacy is maintained in regards to patients’ medical records.
It also created a set of standards to which all electronic medical records must adhere.
What is Health Insurance Portability and Accountability Act of 1996 (HIPAA)?
Allows the advocate to document inquiries without having to click on the Create SR button and choose a Category and Subcategory. It also allows the advocate to select the Primary and Linked Entities.
What is a Wizard SR?
Covers newborn care, under the mother’s maternity benefit, for the first 48 hours after vaginal delivery and the first 96 hours after cesarean delivery. Allows the member up to 30 days from the baby’s date of birth to enroll the newborn.
What is a Newborn Mandate?
Designed to provide support to the patient and their loved ones during the final phase of life. Focuses on comfort and provides a better quality of life, with the goal to enable patient to have an alert, pain-free life and live each day as fully as possible.
What is Hospice Care?