Across
- 3. An identifier assigned by the Centers for Medicare and Medicaid Services (CMS) that classifies the healthcare provider by license and medical specialties.
- 4. A document sent by the insurance company to the provider and the patient explaining the allowed charge amount, the amount reimbursed for services, and the patient's financial responsibilities.
- 6. A process completed before claims submission in which claims are examined for accuracy and completeness.
- 7. An organization that accepts the claim data from the provider, reformats the data to meet the specifications outlined by the insurance plan, and submits the claim.
- 8. The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure or service.
- 9. A payment arrangement for healthcare providers. The provider is paid a set amount for each enrolled person assigned to him or her, per period of time, whether or not that person has received services.
Down
- 1. To settle or determine judicially.
- 2. A set dollar amount that the patient must pay for each office visit. There can be one copayment amount for a primary care provider, a different copayment amount (usually higher) to see a specialist or be seen in the emergency department.
- 4. - Meeting the stipulated requirements to participate in the healthcare plan.
- 5. Software that finds common billing errors before the claim is sent to the insurance company.