Across
- 2. a commercial plan in which the company or group reimburses providers or beneficiaries for services, also sometimes called a fee for service plan which allows subscribers moer flexibility in obtaining services
- 3. payment made to providers by insurance carriers on a per-member, per-month basis
- 5. what is defined as inclusive of policies, procedures and practices as standards for reliable results that include documentation
- 6. when a patient agrees to allow the provider to submit charges on their behalf and for the insurer to send payment directly to the provider
- 7. form provided to Medicare patients when services might not be covered
- 10. approval obtained from the insurer before services are rendered
- 11. after services are provided and the insurer has been billed, a written description of benefits provided to the member by the insurer
- 12. this refers to prcoedures used when a patient has more than one insurance to make sure that the responsible insurer pays for the claim
Down
- 1. reviewing services prior to their provision to determine appropriateness and medical necessity
- 4. the additional information that relates to whether the services aare medically necessary
- 8. this determines the primary insurance when the patient is a child who has health coverage through both parents
- 9. the amount a patient must pay before their insurance begins to pay for services