EMelgar Chap 1&2

3. consumer driven health plan
5. a health plan clearhouse or provider who transmits any health information in electronic form in connection with HIPAA transactions
6. prior authorization from a payer for services to be provided; preauthorization is not received the charge is usually not covered
9. care that is provided to keep patients healthy or to prevent illness, such as routine check ups and screening tests
13. failure to use an acceptable level of professional skills when giving medical services that results in injury or harm to a patient
14. centers for Medicare and Medicaid services
15. record of all charges, payments, and adjustments made on a particular patient's account

1. payment method in which a prepayment covers the provider's services to a plan member for a specifies period of time
2. plan that permits patients to receive medical services from non-network providers
4. standard of conduct based on moral principles
7. national provider identifier
8. method of scrambling transmitted data so it cannot be deciphered without the use of a confidential process or key
10. standards of professional behavior
11. person who makes an accusation of fraud or abuse in a qui tam case
12. a medical practice's written plan for incidents