Individual who enters into an agreement with a health plan that enables individuals to be able to afford medical expenses
What is "Policyholder"
100
Fee paid monthly to a health plan by a person who buys medical insurance
What is "Premium"
100
Payments made by a health plan for medical services
What is "Benefits"
100
The member of this plan, selects a (PCP)
What is "HMO Plan"
100
Physician requires that the prescription be filled exactly as written---no substitution allowed.
What is "DAW 2"
200
Agreement between a person and a health plan that enables individuals to be able to afford medical services
What is "Medical Insurance"
200
Hospital, physician, and other medical staff members and facilities that offer medical services
What is "Providers"
200
The portion customers must pay at the pharmacy, even though the patient has insurance is known as
What is "Co-payment (Co-Pay)"
200
provides benefits to employees and their dependents if employees suffer work-related injuries, illnesses or death.
What is "Worker's Compensation"
200
The number of days a dispensed quantity of medication will last
What is "Day Supply"
300
Funds for Medicaid come from..
What is state and federal government funding.
300
Feature of a policy that provides coverage for selection of prescription medications.
What is "Pharmacy Benefit"
300
List containing the FDA approved brand-name and generic medications a plan covers
What is "Formulary"
(AKA-Preferred drug list/prescription drug list)
300
a person designated by an insurance policy to receive benefits or funds, whom may be the insured themselves, or another person or persons that they select.
What is "Beneficiary"
300
Claims that are sent electronically between the pharmacy management system and the payer
What is "EDI" Electronic Data Interchange
400
Amount paid by a policyholder each year before benefits from a health plan will start
What is "Deductible"
400
Organization that offers financial protection in case of illness or accidental injury
What is "Health Plan" (AKA-Insurance Payers)
400
The criteria patients must meet to be eligible for Medicare.
What is patients aged 65 or older, with disabilities, end of stage diseases.
400
The process by which a provider calls the insurance carrier on behalf of the patient to further explain the reasons for prescribing when the drug is not on the Insurance's formulary list.
What is "Prior Authorization"
400
Possible refusal messages, or denied claim messages a technician may get from insurance companies while processing prescriptions.
What is "patient not covered, refill to soon"
500
An organization that oversees both Medicare and Medicaid.
What is CMS (Centers for Medicare and Medicaid.
500
Actions that can affect continuation of insurance coverage.
What is a birth, divorce, marriage.
500
Part of Medicare that covers hospital charges.
What is "Medicare Part A"
500
Physician authorized generic substitution and (a) patient accepts the generic or (b) a generic is not available
What is "DAW 0"
500
Parts of an insurance card
What is "Patient Name, ID, BIN, PCN, RxGroup, Issuer"