Insurance & PrePro Basics

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Across
  1. 7. A cheaper PPO with higher deductibles and OOP maximums
  2. 11. Insurance plan where employer assumes the risk
  3. 13. A response from the clearinghouse/payer on why claim was not accepted.
  4. 15. Aims to maintain high-quality standards while conserving healthcare expenses
Down
  1. 1. Insurance for those 65+
  2. 2. A rejection that requires sending the claim to a new payer
  3. 3. Insurance plan where employees pay a monthly premium to an insurance company for coverage
  4. 4. Clearinghouse for Med D doses
  5. 5. Processes claims at the local level
  6. 6. The CMS 1500 goes through here. They review and reformat the claim before sending to the payer
  7. 8. Insurance plan that has an assigned PCP and requires a referral to see any specialist
  8. 9. Medical claim form that we send out to payers for services rendered
  9. 10. Insurance plan that has flexible coverage for in and out of network providers
  10. 12. A type of plan that aids in transitioning from one healthcare plan to another
  11. 14. Another word for insurance company
  12. 15. Plans that are provided to those who are categorized at, or below the poverty level