Across
- 2. It is a corporation that provides comprehensive maintenance and acute medical care to patients. It provides preventive medicine, while employing primary care physicians as referrals for more substantial treatment
- 6. The minimum amount which has to be paid by the member to the insurance company before he can claim for benefits
- 9. The process of classifying, evaluating, rating, and assuming risks
- 12. An organization that promotes data interchange and processing standards to the pharmacy service sector of the healthcare industry
- 13. It is the actual pharmacy or drugstore where the prescription is being filled or delivered to the member
- 15. A drug product that does not require a prescription under federal or state law
- 16. A system that is designed to provide drugs in the United States with a specific 11-digit number that identifies the labeler, product, and trade package size
- 17. One of a group of pharmacies under the same management or ownership
- 18. Here the provider bills for a procedure that pays more than the procedure actually performed by the provider
- 20. It is the process used to determine if an individual can receive Healthcare benefits under the plan of coverage
Down
- 1. The process of assigning premium levels to groups
- 3. A federal government program to provide hospital expense and medical expense insurance to elderly and disabled persons
- 4. Instances where a member has benefits from more than one insurance plan
- 5. Entity which underwrites or administers a variety of health and benefit programs. It could be an insurer or a managed care plan
- 7. A specific percentage of the cost of treatment the member has to pay for all covered medical expenses remaining after the deductible has been met
- 8. Price of a prescription drug as identified by drug pricing services, or other sources nationally recognized in the retail prescription drug industry, selected by the Pharmacy Benefit Manager
- 10. A fill fee is an amount that is determined by the plan that is paid to the pharmacy in addition to the calculated price of the drug
- 11. A federally mandated method of identifying all healthcare providers in the United States, including, but not limited to, pharmacies, prescribes, nurses and pharmacists
- 14. The limit on the total coinsurance and deductible you will pay in any calendar year
- 19. When a drug or dispensing limitation does not meet the guidelines of the health plan but the plan wishes to override those guidelines for a specific member, a _______ is issued