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A fixed flat fee you pay for specific medical visits or prescriptions
Copay
Your share of the costs of a covered service, calculated as a percentage
Coinsurance
The amount you pay out-of-pocket before insurance starts paying
Cost Share
What do we call a Participating Provider?
In-network
What do we call a non-participating provider?
Out of Network0
Tool we used to check Status of Appeals
Medhok
Amount you must pay for medical services before our plan begins to pay its share
Deductible
Tools used to check provider participation
GPS, RUMBA, HRP, SFE
EOC means
Evidence of Coverage
MBI Means
Medicare Beneficiary Identifier
TAT for ID card request
8-10 days
Red Blue and White Card
Medicare ID Card
MOOP meaning
Maximum out of pocket
PCP means
Primary Care Provider
HIPAA means
Health Insurance Portability and Accountability Act
Tool used for checking prior auth Status
Medcompass
PHI means
Protected Health Information
TAT for prior auth request
7 calendar days
approval from a health insurance plan required before you receive certain treatments, medical devices, or prescription drugs to guarantee coverage
Grievance
Approval from a health insurance plan required before you receive certain treatments, medical devices, or prescription drugs to guarantee coverage
TAT for Expedited Appeal
72 hours
SWH means
Service with Heart
Meaning of PPO
Preferred Provider Organization (PPO)
CMS means
Center for Medicare and Medicaid Services
TAT for sending materials in ONEKIT
10-14 days