Across
- 3. and Customary (CO/ PR 45) : The charge for health care that is consistent with the average rate or charge for identical or similar services in a certain geographical area
- 5. Amount: Maximum amount on which payment is based for covered health care services This may be called “eligible expense,” “payment allowance" or "negotiated rate"
- 7. Federally administered health insurance program for adults over 65, patients with disabilities and / or End Stage Renal Disease
- 8. Software as a Service (QSI Dental Web/ QDW)
- 9. / Replacement Claim: A bill frequency type alerting the insurance company that the claim submission is an amendment to a previous submission, with altered / additional / corrected information
- 13. A child or other individual for whom a parent, relative, or other person may claim a personal exemption tax deduction and is eligible for health benefits under the subscribers health insurance policy
- 15. : Electronic Data Interchange
- 16. Explanation of Benefits
- 19. Claim Adjustment Reason Codes
- 20. : Park Dental's Clearinghouse
- 21. The policy owner The person who pays health insurance premiums and / or is eligible for group health insurance benefits
- 22. Prepaid Medical Assistance Programs
- 23. The health care items or services covered under a health insurance plan Covered benefits and excluded services are defined in the health insurance plan's coverage documents
- 24. State administered health insurance program for low income or disabled patients
- 25. The patients share of the costs of a covered health care service, calculated as a percentage
- 27. Network: Providers or health care facilities that are part of a health plan's network of providers with which it has negotiated a discount
- 29. Fixed amount due from the patient at point of service, as supplemental to the insurer's payment for outpatient health care benefits
- 33. Coordination of Benefits
- 34. Remittance Advice Remark Code; Supplemental to a CARC
Down
- 1. of Network: a patient seeking care outside the network of doctors, hospitals or other health care providers that the insurance company has contracted with to provide care
- 2. A request for payment that you or your health care provider submits to your health insurer after services are rendered
- 4. Electronic Funds Transfer
- 6. The amount the patient has to pay out-of-pocket for expenses before the insurance company will cover the remaining costs Deductible obligations exclude copayments
- 10. Consolidated Omnibus Budget Reconciliation Act; A Federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event
- 11. / DHMO: A dental health maintenance organization (DHMO) is a structured type of dental plan In this type of plan, a set group of dentists provides dental care and the patient must select a primary provider
- 12. The process of paying claims submitted or denying them after comparing claims to the benefit or coverage requirements
- 14. A type of health insurance arrangement that allows plan participants relative freedom to choose the doctors and hospitals they want to visit
- 17. Electronic Claim Submission
- 18. Bill: When a provider bills you for the difference between the provider’s charge and the allowed amount
- 21. Third Party Liability (ex: workers compensation)
- 26. Electronic Remittance Advice
- 28. Claim: Formerly called Claim Reversal; A provider initiated electronic void is the cancelation of an entire claim
- 30. A request for your health insurer or plan to review a decision or a grievance again
- 31. Advantage, Replacement Policy or Medicare Part C: A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits, in addition to RX and dental benefits
- 32. Accounts Receivable