Insurance Vocabulary

5. A provider that specializes in treating illnesses that disrupt the body's normal hormone absorption and balance, such as Diabetes.
7. A process including verification of education, experience, competence, and licensure of healthcare providers.
8. The process of a health plan and provider/facility negotiating a contract for reimbursement.
13. A facility where skilled nursing care and rehabilitation services are provided on a continuous or daily basis for those recovering from trauma, surgery or disability.
15. This word describes a medical service that is non-invasive and that the patient is able to leave from following its completion.
16. Used to describe a provider that has agreed to accept our payment in full and to coordinate and provide covered services.
19. A provider that specializes in treating illnesses that effect the skin.
20. Codes that describe medical, surgical and diagnostic services. Also called CPT codes and HCPCS. Includes J-Codes for drugs.

1. A facility where exclusively outpatient surgeries are performed.
2. A medical provider who has special training for a certain part of the body or type of illness.
3. The name of Samaritan Health Plan's Medicaid Coordinated Care Organization.
4. An individual or facility that provides healthcare services.
6. A medical professional who manages your health. The first person you call.
9. A member/patient's socioeconomic information expressed statistically - including address, phone number, name and Date of Birth for example.
10. The percentage of the cost of a covered health care service an induvial pay after paying their deductible, billed after the service.
11. Used to describe a provider that does not have a contract with our plan to coordinator or provide covered services.
12. An organization that enables the exchange of healthcare data between a provider and health insurance companies.
14. A fixed amount an individual will pay for a covered healthcare service after their deductible, but before the service.
17. Codes that describe diseases, illnesses and injuries.
18. This word describes a medical service that is invasive and that requires the patient stay and be monitored at a medical facility for a period of time following its completion.