Trivia Time

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Across
  1. 1. An ______ is a formal request to have a decision made by the insurance company reviewed and reconsidered.
  2. 3. Which federal program requires strict marketing compliance and pre-approved materials for its health plan promotions?
  3. 6. A limited-time window when individuals can enroll in or make changes to their health insurance plan without a qualifying event (2 words).
  4. 8. _________ providers have agreed to provide healthcare services to members at pre-negotiated rates (2 words).
Down
  1. 2. A ______ claim means it's not yet approved or denied—more documentation or clarification is needed before a final decision can be made.
  2. 4. The __________ review is a real-time review of a patient's care while they are actively receiving treatment (usually during inpatient stays)
  3. 5. _________ use statistical models and data analysis to estimate future healthcare costs, evaluate risks, and determine how much premiums should be to ensure financial stability for the insurance company.
  4. 7. ____ Rating System is used by CMS to assess Medicare Advantage and Part D plans on quality, outcomes, satisfaction, and compliance metrics.