Insurance 101
A flat fee that a client will pay for every session that will almost never involve a deductible.
What is a copay?
The internal Headway system used to store all provider and patient data.
What is Atlas?
This tool interfaces with Zendesk and allows us to track our requests to the Technical Support Engineering Team
What is JIRA?
OON
What is Out of Network
A uniform numeric coding system used by providers to describe the service(s) provided required on every medical claim. Each code has a specific definition / parameters for the service provided.
What is a CPT code?
The amount the client must meet before the insurance pays any portion of their session fees. This typically resets in accordance with the calendar year.
What is a deductible?
The Headway provider portal, used to manage client files, appointments, and caseloads.
What is Sigmund?
This tool interfaces with Zendesk and allows us send and receive PHI securely.
What is SendSafely?
Ded
What is deductible?
The process of applying to be accepted onto an insurance carrier’s panel (aka the ability to accept insurance!)
What is credentialing?
The percentage that the client is responsible for based on the total session cost and is typically applied after a deductible is met. This can be shown in Atlas in the following formats: percentage OR decimal (ex: 20% or .2 – these would be the same!).
What is Coinsurance?
A commitment between a service provider and a client, including details of the service, the standards the provider must adhere to, and the metrics to measure the performance.
What is a Service Level Agreement?
EPID
A provision that applies when a person is covered under more than one health insurance plan. When a client has two or more insurance plans, they’ll need to ensure this is updated to eliminates over-insurance or duplication of benefits. The primary plan pays first and the secondary plan pays after the primary plan.
What is Coordination of Benefits (COB)
The most money a patient will ever pay for services in a plan year for covered services. Higher than a deductible, these are associated with copays and coinsurance plans. Once reached, the insurance carrier will cover 100% of fees/costs.
What is an Out of Pocket Max (OOP)?
This term is how we sometimes refer to our users seeking care - but no longer use it externally!
What is a patient?
This response gets sent externally to our Headway users, like clients and providers.
What is a public reply?
A bill that healthcare providers (like Headway) submit to a patient’s insurance provider. This bill contains unique medical codes detailing the care administered during a patient visit. The medical codes describe any service that a provider used to render care.
What is a claim?
The code used to designate a specific payer; this is also where claims should be sent. These are nationally recognized codes and can be found on the ID card.
What is an Electronic Payer ID (EPID) Code?
This is Headway’s PC, or professional corporation, and is how our insurance company partners recognize Headway as a large group practice, with a bunch of providers under the umbrella of NYMBHS!
New York Medical Behavioral Health Services (NYMBHS)
This response remains internal, and is only visible to Headway employees and IAs.
What is an internal note?
HIPAA
What is Health Insurance Portability and Accountability Act
A national program that allows Blue Cross and Blue Shield (BCBS) members to access coverage and receive care while traveling or living out of state, in another BCBS service area.
What is the Bluecard Program