Blue Vocabulary

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Across
  1. 6. A Disease Management Benefit focused on the treatment and control of chronic diseases.
  2. 9. A period of one calendar year commencing each January 1 through December 31.
  3. 10. A secure internet portal that provides BCBSMS access for Network Providers, Agents, Groups and Members.
  4. 11. BCBSMS wellness Benefits that includes covered preventative screenings based on age and gender guidelines and most recent peer reviewed best practices guidelines.
  5. 13. An Eligible Person who has satisfied the specifications of the Health and Wellness Benefit Plan's Schedule of Eligibility and has enrolled in coverage.
  6. 15. The term used to describe a person enrolled in the State and School Employees' Health Plan.
  7. 16. BCBSMS internal Member information review tool. Accessed through the intranet, this tool allows BCBSMS employees with access to view information regarding a Member, such as their Health and Wellness Benefit Plan, EOBs, HIPAA Authorizations, and the Member's my Blue account.
  8. 18. That portion of the Allowable expressed as a dollar amount for which the Member is financially responsible under the Health and Wellness Benefit Plan.
  9. 19. The difference between the Total Charge and the Allowable for a Covered Service.
Down
  1. 1. The formal record maintained by a Provider in connection with services provided to a Member.
  2. 2. A BCBSMS intranet workflow tool that assists in documenting departmental decisions and correspondence.
  3. 3. The lesser of the: (1) Covered Charges or (2) the amount established by BCBSMS as the maximum amount for Provider services.
  4. 4. A period of time as determined by BCBSMS or the industry when Applications for a Health and Wellness Benefit Plan are accepted. Also, for an existing Group or Member, the period is the time 30 days prior to renewal when Benefit and enrollment changes are allowed.
  5. 5. A continuous count of days in the year.
  6. 7. A list of prescription drugs
  7. 8. Items which are used to serve a medical purpose, can withstand repeated use, are generally not useful to a person in the absence of illness, injury, or disease, and are appropriate for use in the home.
  8. 12. An Individual's first name or first initial and last name in combination with any one or more of the following: (1) Social Security number; (2) driver's license number; (3) account or ID number.
  9. 14. Program designed to support Members in their decision of choosing to no longer use tobacco (smoke or smokeless). The program covers Network Provider counseling, quitline assistance and Prescription Drug therapy to eliminate tobacco use and dependence.
  10. 17. The collection of Providers that have contracted with BCBSMS to provide health care services.