Individual who enters into an agreement with a health plan that enables individuals to be able to afford medical expenses
What is "Policyholder"
100
Fee paid monthly to a health plan by a person who buys medical insurance
What is "Premium"
100
Payments made by a health plan for medical services
What is "Benefits"
100
10-Step work flow followed at a pharmacy to care for patients' financial matters
What is "Billing Cycle"
100
Payer's processing of claim data to decide whether a drug is covered by the patient's plan and properly utilized
What is "Adjudication"
200
Agreement between a person and a health plan that enables individuals to be able to afford medical services
What is "Medical Insurance"
200
Hospital, physician, and other medical staff members and facilities that offer medical services
What is "Providers"
200
Percentage of the fees owed by the policy holder
What is "Coinsurance"
200
Drug plan benefits received at the time the pharmacy technician insurance specialist processes a person's prescriptions
What is "Point of Sale" (POS)
200
Remaining balance due after an initial payment has been made.
What is "Accounts Receivable"
300
Method of supervising medical care with the goal of ensuring that patients get needed services in the most appropriate, cost-effective setting"
What is "Managed Care"
300
Feature of a policy that provides coverage for selection of prescription medications.
What is "Pharmacy Benefit"
300
List containing the FDA approved brand-name and generic medications a plan covers
What is "Formulary"
(AKA-Preferred drug list/prescription drug list)
300
Information transmitted to a payer that identifies the policyholder, the prescriber, the pharmacy sending the claim, and the medications being supplied
What is "Pharmacy Claim"
300
Claims that are sent electronically between the pharmacy management system and the payer
What is "EDI" Electronic Data Interchange
400
Amount paid by a policyholder each year before benefits from a health plan will start
What is "Deductible"
400
Organization that offers financial protection in case of illness or accidental injury
What is "Health Plan" (AKA-Insurance Payers)
400
Services that a medical insurance policy does not pay for
What is "Noncovered (Excluded) Services"
400
System that stores, processes, transmits, and receives billing data
What is "Pharmacy Management System"
400
Plan that establishes links among provider, patient, and payer by combining the delivery of services with the financing and management of healthcare
What is "Managed Care Organization"
500
Insurance term referring to appropriate medical treatment given under generally accepted standards of medical practice.
What is "Medically Necessary"
500
Monetary amount after which a plan's benefits end
What is "Maximum Benefit Limit"
500
Small fixed fee paid by a patient for a drug
What is "Copayment"
500
Use of software by a physician to transmit an order
What is "Electronic Prescribing" (eRx)
500
Document that comes to a pharmacy showing the details for a claim
What is "Explanation of Benefits" (AKA-Remittance Advice)