Medical Terminology
A flat dollar amount a subscriber pays for medical services.
What is a copay
This indicates an accident.
What is ACC
The type of plan that is PCP centered care.
What is a Partnership Plan.
The plan year for Continuum OAP1500.
What is 1/01 - 12/31
A plan that requires a referral.
What is the Partnership plan
A two digit code that gives additional information on the submitted procedure code.
What is a modifier
This is the statement that is sent to the member advising of payment status.
What is an EOB
The type of plan that has open access.
What is a HP2/RBP plan?
This is applied on a Continuum account when the member does not have a precertification.
What is a 50% penalty
The type of claim form a physician submits their services on.
What is a HCFA
The physician a member selects to manage and coordinate all their health care.
What is a PCP
This is created by the Member Care unit.
What is a CRM
This vender provides precertification and medical necessity review.
What is MedWatch
The benefit code for a primary care office visit.
What is POV
The type of plan where the client funds all claim payments.
What is a Self-Funded Health Plan
A code that identifies diseases and injuries.
What is an ICD10 Code
Centivo's clearinghouse.
What is SDS
What is Cigna
They type of deductible for Stew Leonard PPO Choice.
What is an embedded deductible
Centivo does not follow these guidelines.
What is state guidelines
The maximum dollar amount a covered person will pay for health care services in a plan year.
What is the out-of-pocket
Centivo is not a health insurance, it is a....
TPA
The vender who does clinical edits for Partnership plans.
What is Zelis
The benefit information that can be taken to court.
What is a SPD
The network applied if a member goes out-of-network.
What is PENALTY