NSHD Crossword puzzle- IDR & PDPP 8-2023

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Across
  1. 2. the plan, issuer, or carrier must send an Initial payment or _________ of payment no later than 30 Calendar days after a clean claim is received.
  2. 5. the insurance company/plan and the _______must pay the administrative fee
  3. 8. This type of complaint can be made against the provider or healthcare facility that does not post information about surprise billing in office or on their website
  4. 9. providers should submit this in regards to payment dispute(s) where an issuer or plan is not complying with the decision from the IDRE
  5. 11. The group that makes a decision in an IDR DISPUTE would be the ______.
  6. 12. if required fields aren’t completed on an Unlisted IDR Inquiry complaint, the complaint should not be escalated to _____________.
  7. 13. this KBA is used to submit an inquiry about the IDR process that isn’t related to any other IDR complaint category
  8. 15. Emergency facilities, health plans and issuers can use the IDR process to resolve payment disputes for certain ________ charges.
  9. 17. total number of documents needed for NSA Complaint-IDR Fee Collection
  10. 18. public disclosure of patient protections can be submitted _____________
  11. 19. A provider or facility must disclose to any participant, beneficiary, or enrollee in a group health plan or group or individual health insurance coverage to whom the provider or facility furnishes items and services information regarding federal and state (if applicable) balance billing protections and how to report _______.
Down
  1. 1. multiple claims under same insurance company/plan, same plan type and from same state where provider believes the issuer or insurance company isn’t complying with the IDR process
  2. 3. When a provider asks a complex question about the IDR process, direct them to
  3. 4. evidence of what was sent to the plan/issuer can be provided if an EOP/_________ was never received for an Unlisted IDR Inquiry complaint
  4. 6. These disclosures are intended to help give individuals a clear understanding of their protections under the balance billing provisions of the ____________ and who to contact if they believe those protections have been violated.
  5. 7. Providers must disclose (e.g., display a sign, post on website) patient __________ against balance billing.
  6. 10. the front and back of this card is needed for most IDR complaints
  7. 14. The open negotiation period must last ____ business days.
  8. 16. new bulk provider complaints go to the ____________ queue to be reviewed.