EMelgar Chapt 1&2

4. prior authorization from a payer for services to be provided; preauthorization is not received the charge is usually not covered
6. plan that permits patients to receive medical services from non-network providers
7. consumer driven health plan
8. standard of conduct based on moral principles
10. a medical practice's written plan for incidents
11. standards of professional behavior
13. record of all charges, payments, and adjustments made on a particular patient's account
14. payment method in which a prepayment covers the provider's services to a plan member for a specifies period of time

1. person who makes an accusation of fraud or abuse in a qui tam case
2. a health plan clearhouse or provider who transmits any health information in electronic form in connection with HIPAA transactions
3. method of scrambling transmitted data so it cannot be deciphered without the use of a confidential process or key
4. care that is provided to keep patients healthy or to prevent illness, such as routine check ups and screening tests
5. national provider identifier
9. centers for Medicare and Medicaid services
12. failure to use an acceptable level of professional skills when giving medical services that results in injury or harm to a patient