Across
- 5. A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services
- 7. The process of confirming the healthcare provider's qualifications
- 12. An insurance plan for individuals who are injured on the job or become ill due to job-related circumstances
- 13. The amount paid or to be paid by the policyholder for coverage under the contract, usually in periodic installments
- 15. A medical procedure that is not deemed medically necessary
- 18. An organization that processes claims and provides administrative services for another organization. Often used by self-funded plans
- 20. The set dollar amount that a patient or policyholder must pay before insurance starts to pay for the services rendered
Down
- 1. A set dollar amount that a patient or policyholder must pay before insurance starts to pay at each office visit
- 2. Relatives of military personnel are covered by this government insurance plan
- 3. An approved list of physicians, hospitals, and other providers
- 4. A document sent by the insurance company to the provider and the patient explaining the allowed charge amount, the amount reimbursed for services, and the patient's financial responsibilities
- 6. A decision-making process used by managed care organizations to manage healthcare costs
- 8. A health problem that was present before new health insurance coverage started
- 9. A referral that is used in an emergency situation, as indicated by the provider
- 10. A designated person who receives funds from an insurance policy
- 11. Term for somebody who is poor, needy, or impoverished
- 14. An order from a primary care provider for a patient to see a specialist or get specific medical services
- 16. The length of time a patient waits for disability insurance to pay after the date of injury
- 17. For the insurance to pay for services, this must be submitted
- 19. A low-income patient may be eligible for this insurance