1
Other than billing lady, this person most frequently files claims and handles payments
Who is the MA
The person whose name the insurance is carried under is called the
Who is subcriber, member, policy holder, or insured?
Word that describes the annual cost of ins often paid monthly
what is premium?
Fixed dollar amount that must be "met" or paid before ins pays a dime
What is deductible?
Rule by which the person whose birthday comes first in the year decides the primary ins for a dependent
What is birthday rule?
This form alerts a pt that a service is not covered by MCARE & allows them to make an informed decision
What is ABN?
This type of plan commonly pays via capitation
These are usually filed within a few days after a DOS
what are claims?
These types of claims are most cost effective
What are electronic claims?
You should change your EHR password this often
What is every 90days?
These gov't funded ins is for Military personnel and dependents
What are Tricare and ChampVA?
This is the process of comparing provider fees to the allowed benefits of an ins plan
What is review for allowable benefits?
To determine eligibility, MCAID looks this far back at your income
What is 1 month?
This Tricare plan allows a retired Military worker, aged 65+, to continue using miliitary facilities
Worker's comp commonly covers this service to allow a pt to eventually return to work after some therapy
What is rehab?
10 digit number that is added to a claim to identify a provider's specialty
What is Taxonomy code?
This is a monthly, fixed payment a provider receives for a pt no matter how many times a pt is seen that month
What is capitation?
After turning 65, you must enroll in this plan if you want it
What is MCARE part B?
This required info must be entered before sending a claim
what are data elements?
For retired military personnel over 65 yrs of age, they may qualify for this ins for with Tricare for life as their secondary
What is MCARE?
This process is done after obtaining a prior authorization and has the ins decide amount to be paid for a service
What is predetermination?
This is considered a healthcare cost assistance program, not health ins
What is MCAID?
Hospital stays, nursing homes, rehab, hospice, and respite care are covered under this part of MCARE
What is part A?
This is how a clearing house receives the data elements of a claim
What is cpu file?
Have a great 4 day weekend!
;-)