Across
- 2. schedule A list of fixed fees for services.
- 4. The amount paid or to be paid by the policyholder for coverage under the contract, usually in periodic installments.
- 5. A written agreement between two parties in which one party (the insurance company) agrees to pay another party (the patient) if certain specified circumstances occur.
- 6. period The length of time a patient waits for disability insurance to pay after the date of injury.
- 7. A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services.
- 9. A designated person who receives funds from an insurance policy.
- 11. network An approved list of physicians, hospitals, and other providers.
- 13. insurance Web portal An online service provided by various insurance companies that allows providers to look up a patient's insurance benefits, eligibility, claims status, and explanation of benefits.
- 14. administrator An organization that processes claims and provides administrative services for another organization. Often used by self-funded plans.
- 16. A payment arrangement for healthcare providers.
- 17. A formal request for payment from an insurance company for services provided.
- 18. Medicare Beneficiaries Low-income Medicare patients who qualify for Medicaid for their secondary insurance.
- 20. condition A health problem that was present before new health insurance coverage started.
Down
- 1. relative value system (RBRVS) A system used to determine how much providers should be paid for services provided. It is used by Medicare and many other health insurance companies.
- 3. of benefits 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.
- 8. An order from a primary care provider for the patient to see a specialist or to get certain medical services.
- 10. Poor, needy, impoverished.
- 12. management A decision-making process used by managed care organizations to manage healthcare costs. It involves case-by-case assessments of the appropriateness of care.
- 15. The primary care provider, who is in charge of a patient's treatment. Additional treatment, such as referrals to a specialist, must be approved by the gatekeeper.
- 19. insurance exchange An online marketplace where people can compare and buy individual health insurance plans. State 244health insurance exchanges were established as part of the Affordable Care Act.