Across
- 3. When the member tell us that they disagree with Health Partners’ decision to deny, reduce or stop a service or item you requested, or to approve a different service or item in its place.
- 4. When the member tells us that they are unhappy with Health Partners, for a decision we’ve made, or a participating provider.
- 9. Services or supplies that are needed for the diagnosis or treatment of your medical condition, and meet acceptable standards of medical practice.
- 10. The amount a member may be required to pay as their share of the cost of medical service or supply, (usually a set amount, rather than a percentage)(Hyphenated Word).
- 13. Approval by the plan required before some types of healthcare services are performed(only use one word).
- 16. A Beneficiary who requests to terminate from their Health Insurance plan.
- 19. Request to apply for Health Insurance coverage.
- 21. A patient who is admitted to a hospital or clinic for treatment that requires at least one overnight stay.
- 24. A regulation to guarantee patients new rights and protections against the misuse or disclosure of their health records(acronym).
- 25. Medicaid's comprehensive and preventive child health program for individuals under the age of 21(acronym).
Down
- 1. A code in PowerMHS used to define a provider’s hospital affiliation(acronym).
- 2. Is the traditional method of payment for health care services where specific payment is made for specific services rendered.
- 5. A fixed amount a health care plan will reimburse provider for services
- 6. Certain medical equipment that is ordered by a doctor for use in the home(acronym).
- 7. The code in MHS used to identify the exact plan in which the member is enrolled.
- 8. Permanent kidney failure that requires a regular course of dialysis or a kidney transplant(acronym).
- 11. Conditions that must be met in order to participate in a plan.
- 12. A provider contracted with the plan to provide care/services to its members(abbreviated).
- 14. A healthcare professional who works with members to assure that they receive needed services and extra help that they may need to access these services.
- 15. A bill that a provider submit requesting payment for services rendered.
- 17. A provider has opted not to contract with the plan to provide care/services to its members(abbreviated).
- 18. A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
- 20. A program sponsored by the federal government and administered by states that is intended to provide health care and health-related services to low-income individuals.
- 22. Refers to another entity that is responsible for the payment of medical expenses. This entity is usually another Health insurer(acronym).
- 23. The State agency which administers the Temporary Assistance for Needy Families and General Assistance programs(acronym).