Across
- 3. claim, a claim held or rejected by the insurance car- rier due to problems or errors
- 6. provides health insurance coverage for children under 19 years of age in families who are not eligible for Medicaid but can- not afford private coverage
- 7. payment made to a provider based on a fixed amount per enrollee assigned to that provider regardless of services provided
- 8. using several CPT codes to identify proce- dures normally covered by a single code
- 9. 1500, universal health insurance claim form used in the physician's office
- 10. claim, completed insurance claim form submitted to a carrier without deficiencies or errors
- 11. a bill sent to the insurance carrier for payment re- lated to patient care
Down
- 1. rule, a method used to determine the primary insurance carrier when children are covered under both parents' insurance plans; the parent whose birthday falls earliest in the calendar year becomes the primary carrier
- 2. under health plans, individuals are required to receive advance authorization from the insurance provider for particular medical services; usually required for re- ferral to a physician specialist
- 4. a set amount owed by the insured at the time of is waiving of co-payment by the medical office is against federal guidelines for Medicare and Medicaid; sometimes referred to as co- insurance which is not correct
- 5. coding system first published by the American Medical Association in 1966; a manual, updated annually, that contains the codes for procedures and services performed by doctors and other select medical personnel
- 6. a percent of the covered insurance payment owed by the individual to the provider for the service
- 8. deliberately using an incorrect code to bill at a higher rate
- 10. a service benefit program with no premiums for select family members of specific, usu- ally not retired, veterans