Terminology
This service is commonly used by STM members and provides assistance in finding a medical provider that the member can visit.
Verified Provider List (VPL)
This man, along with his wife, created TheKarisGroup in response to growing concerns over skyrocketing costs of medical treatment.
Tony Dale
The client, currently known as HealthInsurance, used to go under this name
Benefytt Technologies
These two forms of documentation are required for the approval of a bill negotiation case.
1) MIRF
2) Bills from the provider (Or just bills)
Usually accompanied by medical bills, this document is given to the patient once their bills are done processing with the insurance.
Explanation of Benefits (EOBs)
These codes offer doctors and health care professionals a uniform language for coding medical services and procedures.
*DOUBLE POINTS IF YOU KNOW THE FULL NAME*
CPT codes
*bonus answer*
Current Procedural Terminology
TheKarisGroup, a company that specializes in healthcare patient advocacy, was founded in this year.
1996
This client is considered a sister company to PointHealthTech
Sedera
The title given to the navigation team members before (and shortly after) the transition to Point Health / PointHealthTech
Member Advisor
This document, required for multiple services, has a one-year expiration date and can be revoked by the member at any time.
MIRF
(Medical Information Release Form)
This group is part of Premier Health and has the abbreviation (AOBG)
American Online Benefits Group
This meeting is scheduled every few months and provides additional learning information to multiple departments
Education Connection
These two clients have a $1000 minimum OOP and $350 minimum per bill threshold for bill negotiation
Pivot Health / Coverdell
**Other acceptable answers**
Lincoln Heritage/Companion Life
These three options are provided to Pivot STM members when assisting in finding a doctor
1) VPL
2) Self-reimbursement
3) NavigoHealth
This number, rounded to the nearest thousandth, was the total number of cases completed by the navigation team in 2022
12000
This action, currently banned in 33 states, involves a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays.
Balance billing
*Other acceptable answer*
Surprise billing
The total number of teams within PointHealthTech
*BONUS POINTS FOR LISTING AT LEAST 4 OF THEM*
6
1) People Operations/HR
2) OPS/IT
3) Navigation
4) Patient Advocacy
5) Client Services
6) Management/Leadership
These three sub-plans are amongst the most common for Health Depot members
1) Secure Choice
2) FocalPoint
3) HD True Choice
These criteria must be met before an upfront negotiation case can be opened.
1) The procedure must be self-pay.
2) The procedure must be scheduled.
3) The procedure must be more than 7 days away.
*additional option*
Payment must be due.
Since 2007, PointHealthTech (formerly TheKarisGroup), managed to save members this average percentage off their medical bills.
(Within at least 5% of the points)
44%
This client, currently known as KHC, was formerly called this name
The Health Co-Op
Issues registering, logging into, or navigating the Point Health App are known as this
Tier 1 Issues
*Other acceptable answer*
User Education Tier
The client, Coverdell (Lincoln Heritage), provides members with a fulfillment pamphlet that shows these two benefits that come with their plan.
1) Final Affairs Settlement
2) Medical Bill Negotiation
A client can request this specialized service when a member has a medical bill with a date of service prior to their enrollment date.
Pro-Bono
Also known as an ENT, this specialty assists and diagnoses patients with Ear, Nose, and Throat issues.
Otolaryngology