Module 1
Person owns/pay for the policy
Insured/subscriber/policy owner
PHI abbreviation meaning
Protected health information
An add-on that required additional charges on insurance
Rider
Term used when provider is in contract and can offer discounts
Participating (PAR)
Number of codes allowed per call
10
An insurance plan that is purchased by an employer/company
Group insurance
These info are considered PHI
Name, Medical history, Address, treatment etc
Money paid monthly on the insurance plan
Premium
Expenses that member pays on their own for covered/non covered services
Out of pocket payment
How can claims be submitted
Email, Fax, Electronically, portal and mail
Programs assisted and funded by the government
Medicare and Medicaid
It isn't necessary to verify a provider one they mention they are calling from the Doctor's office T/F
False
12 Month time frame for claim submission is known as what?
Timely Filling
Classification name for services that members do to prevent illness/further issues
Primary tool used to access provider and patient information
Skygen
All parties covered/linked with the insurance policy
Patient Provider and Payer
Health care provider can discuss patients PHI under what conditions
Treatment, consultation, operation, payment
This is the money that is given on the insurance plan for services during the plan/calendar year
Annual max
% of the medical cost that will be paid
coinsurance
# of mandatory verification steps for members
3
Largest single payer of health care in the US
The federal government
This 1996 act was created to protect patient health information and streamline the healthcare process
HIPAA
Date that the service was rendered
DOS (date of services)
Money the member needs to pay to be eligible for other services
Deductible
What an be used to locate a provider