pharmacy
drug spend definition
the amount the member and the plan have spent towards covered medications
DMR
dental reimbursement
ICD-10 DX codes
3-7 character codes + numeric. Decimal used after third character. First character is always a letter. Second is always a number. (ex: A12.34)
used to send blank forms
onekit
Nates favorite color
purple
generic drugs definition
A generic drug is a copy of a brand-name drug that no longer has a patent. The cost is usually less than the brand-name drug.
MSB
mandatory supplemental benefits
Benefits automatically embedded
CPT-4 code
Will always be 5 digits long. (ex:12345)
used to view documents that are pre filled
Outbound correspondence OBS
When are we done with this class and start soft landing?
Nov 2nd
Negotiated Cost
The cost Aetna has contracted with the pharmacy for a covered medication.
OSB
optional supplemental benefit
No dental coverage unless they elect that
whats this code and who uses them for what-
12.34
ICD-9 PX codes
Used by hospitals to describe surgical procedures.
View appeals and grievance status
STARS
What can you catch, but not throw?
a cold
Catastrophic Coverage Stage - whos it paid by and when does it end?
Paid by: Member and Plan
The member remains in this stage until the end of the plan year (December 31st).
COMBO
combo of mandatory and optional benefits
Basic preventative coverage but can elect the OBS coverage during election period
ICD-10
has a letter in the front (same format as ICD-9 but has a letter in the front)
view claims and all details
ECHS
No matter how little or how much you use me, you change me every month. What am I?
A calendar.
True Out of Pocket (TrOOP) definition
The amount that is paid by the member or on the member's behalf towards covered medications.
whats included in the basic dental plan
standard preventive services with additional coverage for full mouth x-rays, periapical x-rays, fillings, extractions, scaling & root planning, periodontal maintenance, non-molar root canals, palliative treatment and some restorative repairs
what is a 5 digit codes that start with "0"
CDT-1 dental terms
look up providers to see their specialties, TIN, addresses, ect.
Smart front end
What runs around the whole yard without moving
Fence.