Medicaid Vocabulary

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Across
  1. 3. When the member tell us that they disagree with Health Partners’ decision to deny, reduce or stop a service or item you requested, or to approve a different service or item in its place.
  2. 4. When the member tells us that they are unhappy with Health Partners, for a decision we’ve made, or a participating provider.
  3. 9. Services or supplies that are needed for the diagnosis or treatment of your medical condition, and meet acceptable standards of medical practice.
  4. 10. The amount a member may be required to pay as their share of the cost of medical service or supply, (usually a set amount, rather than a percentage)(Hyphenated Word).
  5. 13. Approval by the plan required before some types of healthcare services are performed(only use one word).
  6. 16. A Beneficiary who requests to terminate from their Health Insurance plan.
  7. 19. Request to apply for Health Insurance coverage.
  8. 21. A patient who is admitted to a hospital or clinic for treatment that requires at least one overnight stay.
  9. 24. A regulation to guarantee patients new rights and protections against the misuse or disclosure of their health records(acronym).
  10. 25. Medicaid's comprehensive and preventive child health program for individuals under the age of 21(acronym).
Down
  1. 1. A code in PowerMHS used to define a provider’s hospital affiliation(acronym).
  2. 2. Is the traditional method of payment for health care services where specific payment is made for specific services rendered.
  3. 5. A fixed amount a health care plan will reimburse provider for services
  4. 6. Certain medical equipment that is ordered by a doctor for use in the home(acronym).
  5. 7. The code in MHS used to identify the exact plan in which the member is enrolled.
  6. 8. Permanent kidney failure that requires a regular course of dialysis or a kidney transplant(acronym).
  7. 11. Conditions that must be met in order to participate in a plan.
  8. 12. A provider contracted with the plan to provide care/services to its members(abbreviated).
  9. 14. A healthcare professional who works with members to assure that they receive needed services and extra help that they may need to access these services.
  10. 15. A bill that a provider submit requesting payment for services rendered.
  11. 17. A provider has opted not to contract with the plan to provide care/services to its members(abbreviated).
  12. 18. A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
  13. 20. A program sponsored by the federal government and administered by states that is intended to provide health care and health-related services to low-income individuals.
  14. 22. Refers to another entity that is responsible for the payment of medical expenses. This entity is usually another Health insurer(acronym).
  15. 23. The State agency which administers the Temporary Assistance for Needy Families and General Assistance programs(acronym).