Eligibility, Medical Coding, Plan Types and Pricing

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Across
  1. 2. Used to report medical, surgical, and diagnostic services, 5 digit numeric code.
  2. 3. Point C's preferred method of pricing, claims go to the network then are returned to us
  3. 4. 2 digit code that is used to further describe services rendered.
  4. 7. the date a members coverage ends
  5. 11. set by the employer, determines how long a member has to wait until eligible for benefits
  6. 12. used on a UB claim to determine the type of facility where services were rendered
  7. 15. ICD-10 codes, describe the reason for the service
  8. 16. the contracted rate between a provider and the network used to pay a claim
  9. 17. the state of having the right to do or obtain something through satisfaction of certain requirements
Down
  1. 1. when a member can be added due to birth, adoption, marriage etc
  2. 5. the time of year when you elect benefits annually.
  3. 6. Point C's reference based pricing vendor
  4. 8. no contract exists between a provider and the network. Example, Dr. Jane Smith does not have an agreed upon rate with Aetna.
  5. 9. the date a member is active
  6. 10. used to report medical procedures and services to Medicare, Medicaid, and other health insurance programs. Level II codes also cover products, supplies, and services not included in CPT codes. Alphanumeric codes.
  7. 13. electronic data interchange
  8. 14. pricing type used when a contracted exists between a provider and a network. Example Dr. John Smith has an agreed upon rate with Aetna.