Billing & Reimbursement

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Across
  1. 2. Meeting the stipulated requirements to participate in the health care plan
  2. 4. A fixed amount the patient pays for a covered service after the deductible is met
  3. 5. 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
  4. 6. To settle or determine judicially
  5. 7. After the deductible has been met, the policyholder may need to pay a certain percentage of the bill and the insurance company pays the rest
  6. 11. A set dollar amount that the policyholder must pay before the insurance company starts to pay for services
  7. 12. A claim that contains errors that were identified before the claim was processed by the payer
Down
  1. 1. 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
  2. 3. 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
  3. 8. Software that finds common billing errors before the claim is sent to the insurance company
  4. 9. A process done before claims submission to examine claims for accuracy and completeness
  5. 10. A claim that was received and processed by the payer and found to be unpayable