Contact Centre Jargon

2. A fixed percentage that you pay each time for a certain service or product.
4. A question from a Member or Provider
7. An investigative process to see if a benefit will pay
9. Specific dollar amount that an insurer must satisfy during a specific period of time before reimbursement can be received from their plan.
11. Another word for a client who receives health insurance benefits
13. A process to request action when a cheque may have been lost, stolen, destroyed, or mailed to an incorrect address
15. When a claim is resubmitted with required information in order to be paid.
16. The Medavie Blue Cross system used to locate information and coverage for Private & CIC Members
17. The Medavie Our Claims Workflow & Imaging technology
18. The Medavie Blue Cross Claims Adjudication System

1. A set dollar limit for certain benefits and services in a specified time period.
3. A rule that outlines how often a member can have services or products in a specific time frame.
5. A summary of all cheques issued to the Member or Provider under the applicable ID
6. When a claim was paid incorrectly. To correct a date of service, amount billed, wrong benefit code or when a Medavie Blue Cross cheque is returned and must be cancelled, or when a partial or full refund is received from the member or provider.
8. Coordination of Benefits is a procedure developed for individuals covered under more than one health insurance policy. It requires that payment of benefits is coordinated by all plans to eliminate duplication of benefits.
10. The Medavie Blue Cross system which houses all Provider information
12. The Medavie Blue Cross Pharmacy Claim Adjudication System
14. Health professionals who provide health care services. Such as; Doctors, Chiropractors, Dentists, Pharmacies or many others offering specialized health care services.
17. The Medavie Blue Cross system used to locate information and coverage for RCMP and CF members.