Premier Terminology

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Across
  1. 1. Geographical Managed Care- Sacramento County. Group #5555
  2. 5. Primary Dentist a Member is assigned to for services
  3. 6. Client Index Number
  4. 8. Indicated Member seen for preventative services (exam, cleanings, and/or x-rays) where Provider already received payment under capitation
  5. 10. Set time of year when participants can enroll in health insurance or change from one plan to another without a qualifying event
  6. 13. Los Angeles Pre-Paid Health Plan – Los Angeles County. Group #4444
  7. 14. Group of physicians, hospitals, and other providers who participate in a managed care plan
  8. 16. Health plans offered to specific group of individuals by an employer, association, union, or other entity
  9. 19. Provider who is not contracted with an administrating network
  10. 20. Provider ID number
  11. 21. Predetermined amount a member will pay up front for specific services such as office visits
  12. 23. Statement showing the payments attached to checks sent to providers
  13. 24. Defines the scope of the coverage afforded (i.e. missing tooth clause- indicates if a tooth is lost prior to insurance coverage beginning the coverage does not cover replacing the tooth.
  14. 25. Statement sent to a member or provider to explain the insurance benefits of a claim
  15. 26. Statement indicating that proposed dental treatment will be covered under the terms of the benefit contract
  16. 27. Benefits paid when patient is out of area and needs emergency services
Down
  1. 2. Providers receive a set payment per month for every assigned Member regardless if they are seen in office or not.
  2. 3. Negotiated rate providers agree to charge for services
  3. 4. Changing Primary Care Dentist during the month after rosters are finalized and sent to providers
  4. 7. List of assigned Members for a specific Provider or provider office
  5. 9. State of California employee Commercial Dental plan. Group # 12700
  6. 11. General description of benefits Members are eligible to receive under the plan
  7. 12. More than one insurance carried, and coverage is divided between the different carriers.
  8. 15. Provider contracted with the network
  9. 17. Provision of an insurance policy that is purchased separately from the basic policy and provides additional benefits at an additional cost
  10. 18. Preferred Provider Organization
  11. 19. Office ID number
  12. 22. Dental Health Maintenance Organization