Across
- 7. A cheaper PPO with higher deductibles and OOP maximums
- 11. Insurance plan where employer assumes the risk
- 13. A response from the clearinghouse/payer on why claim was not accepted.
- 15. Aims to maintain high-quality standards while conserving healthcare expenses
Down
- 1. Insurance for those 65+
- 2. A rejection that requires sending the claim to a new payer
- 3. Insurance plan where employees pay a monthly premium to an insurance company for coverage
- 4. Clearinghouse for Med D doses
- 5. Processes claims at the local level
- 6. The CMS 1500 goes through here. They review and reformat the claim before sending to the payer
- 8. Insurance plan that has an assigned PCP and requires a referral to see any specialist
- 9. Medical claim form that we send out to payers for services rendered
- 10. Insurance plan that has flexible coverage for in and out of network providers
- 12. A type of plan that aids in transitioning from one healthcare plan to another
- 14. Another word for insurance company
- 15. Plans that are provided to those who are categorized at, or below the poverty level