A
An insurance that is not offered and managed by a government entity.
Commercial Health Insurance
It usually refers to the plan/ state in which the patient takes treatment besides his/her home plan.
Local Plan
The claim form generated could be sent to the insurance in two ways. What are those?
Paper Claim and Electronic Claims
It is the database contains information for each uniformed service member, Department of Defense (DoD) and uniformed services civilians, other personnel as directed by the DoD, and their eligible family members.
Defense Enrollment Eligibility Reporting System or DEERS
What do you call a provider who not in contract with the patient’s insurance.
Non-Participating Provider or Non-Par
It is a national social insurance program, administered by the U.S. federal government since 1966. It is administered by CMS
Medicare
It is always the Payer of Last Resort
Medicaid
A type of Hospital for terminally ill patients with a life expectancy of not more than 6 months.
Hospice
A type of Hospital or facility which is also called as Day Surgery or Same-Day-Surgery (SDS)
Ambulatory Surgery Centers
A type of commercial insurance that covers both in-network providers (like an HMO), or out–of- network providers (like a PPO) but cheaper.
POS or Point of Service
A type of patient where in Date of last visit is within 3 years or later.
New Patient
Its main task is to diagnose and assist patients with routine check-ups and examinations.
PCP or Primary Care Physician
formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), is a health care program of the United States Department of Defense Military Health System.
TRICARE
It is a health insurance plan that employers are required to have to cover employees who get sick or get injured on the job.
Worker's Compensation
It is an insurance that can pay or cover injuries to others and damage to other’s property resulting from an accident an individual cause.
Auto Liability Insurance
It is or institution which is licensed by the federal government to provide healthcare services
Provider
It is also known as insurance, carrier, or insurer.
Payer
It is a code use to indicate the setting in which a service was provided
Place of Service code
What is the name of the document that is being sent to the patient and provider to decision of the insurance to a filed Claim?
EOB or Explanation of Benefits
Which Medicare part covers DME or Durable medical equipment
Part B
Medicare claims must be filed no later than______ months
12 months
is a national program that enables members of one BCBS Plan to obtain healthcare services while traveling or living in another BCBS Plan's service area.
Blue card
It is a code that describes a medical test completed or treatment provided to the patient.
CPT Codes
This is the maximum time limit given by an insurance toa provider for submitting claims for payment. This starts from the date of service.
TFL or Timely Filing Limit
This is one of the Provider Identifier that issued by CMS (Centers for Medicare and Medicaid Services)/HCFA.
NPI