Across
- 3. Used to suppress certain opportunities based on defined criteria
- 5. The facilities/departments that are encompassed in the Cloudmed Review
- 7. Proprietary logic of grouping like items or services into categories which are used to trigger or resolve rules
- 9. A document managed by lead auditors to track client-specific requirements and guidelines
- 10. In this type of payment, the primary payer makes a supplemental payment reflecting the shift in the HCPCS/CPT code.
Down
- 1. A rate that kicks in when billed charges exceed a defined threshold
- 2. A process during which the Rules Team validates things like contract mapping, rule values, and opportunity state
- 4. Another name for an Insurance Company
- 6. The term that describes an opportunity that is marked 'Change Applied' but has not been paid/resolved
- 8. This contains the terms of agreement between a health system and individual insurance payors