Across
- 2. direct member reimbursement
- 3. acronym for durable medical equipment, medical equipment intended for long use such as wheelchair, oxygen equipment, insulin pump
- 4. acronym for Explanation of Benefits, this is a written explanation to a member of how a claim was paid
- 6. a fee the member pays when they receive certain health care services or prescription
- 7. the doctor that manages member care and refers them to specialty care if they need it.
- 10. required for some services as a condition for payment, process of obtaining and documenting prior authorization from the health plan submitted by the provider before delivering services
- 13. Health Insurance Portability and Accountability Act
Down
- 1. an expression of dissatisfaction about any matter other than an adverse benefit determination
- 2. equipment that primarily serves a medical purpose, for everyday or extended use. Examples- wheelchairs, oxygen equipment, hospital bed
- 5. a doctor who provides health care services for a specific disease or part of the body. Examples- cardiologist (care for heart), orthopedist (care for bones)
- 8. over-the-counter
- 9. power of attorney
- 11. request made by the PCP for member to be evaluated/treated by a different physician, usually a specialist
- 12. a request to review an "adverse benefit determination" (denial) for services that the member believes they are entitled to receive