WellCare

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Across
  1. 2. / provide information about products and services, take orders, respond to customer complaints, and process returns.
  2. 5. / business where drugs approved by a doctor are legally sold.
  3. 7. / when a member calls into customer service
  4. 8. / any oral or written request to a health plan, provider or facility without an expression of dissatisfaction
  5. 9. / A prescription drug that has the same active-ingredient formula as a brand-name drug.
  6. 13. / The amount of covered health care expenses you must pay yourself each year before your insurance will begin to pay.
  7. 17. / Eligible beneficiaries who have limited income may qualify for a government program that helps pay for Medicare Part D prescription drug costs
  8. 18. / the federal communications commission issued a number of regulations interpreting the telephone consumer protection act.
  9. 22. / is a list of prescription drugs, both generic and brand name, used by practitioners to identify drugs that offer the greatest overall value
  10. 23. / is usually necessary to see any practitioner or specialist
  11. 25. / focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
  12. 26. / A limit in a range of major life activities
  13. 28. / the act of compensating someone for an out-of-pocket expense by giving them an amount of money equal to what was spent
  14. 31. network / The hospitals and doctors that contract with your health plan to provide services for an agreed-upon rate or fee schedule.
  15. 33. / team that performs outreach to members
  16. 34. / person covered by an insurance policy.
  17. 36. care / is a complex system responsible for coordination financing & delivery of health benefits.
Down
  1. 1. / includes all payments for Medications listed on your plan's formulary and purchased at a Network or participating Pharmacy.
  2. 3. / CCP members are considered ____ when they move or reside outside of their current CCP service area for a period exceeding 6 consecutive months.
  3. 4. / an individual or independent practice association (IPA) that oversees care for a member.
  4. 6. / is the federal health insurance program
  5. 10. / a widely recognized, evidence-based program dedicated to quality improvement and measurement.
  6. 11. / Supplemental services not covered by the original Medicare such as: hearing, vision and/or dental benefits
  7. 12. / The process of putting the insurance policy back after a lapse
  8. 14. / Conditions for which the insurance company will not pay; for example, cosmetic procedures are exclusions.
  9. 15. / it is a set of healthcare quality measures designed to measure how well health plans follow accepted standards for prevention and treatment. it is one of the most widely used sets of healthcare performance measures in the United States and continues to evolve on an annual basis.
  10. 16. / a feeling of resentment cause for a complaint over something believed to be wrong or unfair.
  11. 19. / refers to any of the procedures that deal with the review of adverse coverage determinations made by the plan regarding the benefits under a plan.
  12. 20. / when you request reimbursement or direct payment for medical services obtained.
  13. 21. / he process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider
  14. 24. / is submitted by the provider and/or facility to the insurance payer, giving the provider and/or facility the go-ahead to perform the necessary service
  15. 26. / enrolled individuals who are entitled to both Medicare & medical assistance from a state plan under Medicaid
  16. 27. / The _____that your medication is in determines your portion of the drug cost
  17. 29. / is the Medicare advantage and prescription system user interface.
  18. 30. / If you're qualified for something or allowed to take part in it
  19. 32. / The conditions for which the insurance company will pay.
  20. 35. / annual notification of change