Vocabulary
A specific amount of money that must be paid yearly before the benefits begin.
What is a Deductible
Laws that protect wage earners against the loss of wages and the cost of medical care resulting from occupational accidents and diseases.
What is Workers Compensation
Offered to all medicare recipients to cover the cost of their prescription drugs.
What is Medicare Part D
A state to state health benefits program designed for low income people, and those who are blind, disabled, members of families with dependent children deprived of the support of at least one parent.
What is Medicaid.
A standard designed to protect medical records and all personal health information.
What is the Health Insurance Portability and Accountability Act
The amount of time that an individual must wait to become eligible for coverage or a specific benefit.
What is a Waiting Period
A managed care organization developed to control the expenditure of health care dollars and to manage patient care.
What is a Health Maintenance Organization
Covers outpatient health care services, services by physicians and durable medical equipment.
What is Medicare Part B
What is a comprehensive health care program that the Office of Veterans' Affairs share the cost of covered health care services and supplies with eligible beneficiaries?
What is ChampVA
When an insurer determines whether an insurance claim is correct and able to be paid, and if so makes payment.
What is Claims Adjudication
Conditions like acquired immunodeficiency syndrome, attempted suicide, cancer, losses due to injury on the job, and pregnancy are reasons why a person should not be allowed to deduct expenses
What is a Policy Limitation
A plan in which the members may seek care outside the network, or directly from preferred providers.
What is Point of Service
Inpatient health care services, services in hospitals, nursing facilities, home health care, and hospice care.
What is Medicare Part A
A fee for service plan for the dependents of men and women in the military.
What is Tricare Standard
Medicare Part B coverage requires you to use this universal claim form.
What is a CMS 1500
The cost of the coverage that the insurance policy contains may vary greatly depending on the subscriber.
What is a Premium
Enrollees receive the highest level of benefits when they obtain services from a physician, hospital, or other health provider designated by their program as a preferred provider.
What is a Preferred Provider Organization
Some varieties of this plan may require members to pay a premium similar to the Medicare Part B premium.
What is Medicare Part C
A health maintenance organization plan with a point of service option for the dependents of men and women in the military.
What is Tricare Prime
The intentional deception or misrepresentation that results in unauthorized benefits to an individual or organization.
What is Health Insurance Fraud
The approval of or concurrence with the treatment plan proposed by a medical professional before the provision of services will be covered by insurance
What is Preauthorization
These groups sign up health care providers who agree to charge a fixed fee for services.
What is a Managed Care Program
Medicare is a federal program authorized by Congress and administered by this group.
What is Centers for Medicare & Medicaid Services
A preferred provider organization plan for the dependents of the men and women in the military.
What is Tricare Extra
In the pharmacy, This person tracks claims, processes and verifies accuracy of payments, and files secondary payer claims.
Who is the Insurance Specialist