Across
- 3. A digital version of an EOB; a document describing how much of a claim the insurance company will pay or why the claim was denied.
- 4. A provider or facility that does not have a contract or agreement with a patient's health insurance plan.
- 6. The maximum units of service allowed for a HCPCS/CPT code on the vast majority of appropriately reported claims by the same provider/supplier for the same beneficiary on the same date of service.
- 10. A health plan that covers in and out-of-network providers, though in-network providers are generally cheaper for the patient.
- 11. a private health care insurer that has been awarded a geographic jurisdiction to process Medicare claims.
- 14. Describe why a claim or service line was paid differently than it was billed.
- 15. The electronic network that collects information before delving it out to particular individual insurance providers.
- 16. Basic patient information that remains classified.
- 17. A doctor selected by the member to be the first physician contacted for any medical problem.
- 18. Protects consumers from unexpected out-of-network balance billing in emergencies and in situations in which a patient goes to an in-network hospital but unknowingly receives care from an out-of-network provider while at the hospital.
- 19. Edit for pairs of services that normally should not be billed by the same physician for the same patient on the same date of service.
- 20. This is which insurance agency is the primary provider versus the secondary provider when a patient has more than one policy.
Down
- 1. Provides additional explanations for an adjustment already described by 2 across or convey information about remittance processing
- 2. A healthcare policy that requires a gatekeeper or primary care physician.
- 5. A unique ID number for certain health care providers.
- 7. Digitally formatted health records
- 8. Privacy rule of the health industry that outlines the use and/or distribution of personal health information for specific organizations.
- 9. Level II is for products, supplies and services not otherwise included (ambulance services, DME, prosthetics, orthotics or supplies used outside a doctor's office).
- 12. Numeric coding system maintained by the American Medical Association that describes medical services and procedures.
- 13. The specific number assigned to an individual for tax filing and tracking purposes.
- 15. A document attached to a processed claim that explains to the provider and patient what the insurance company provides, usually consisting of covered charges, payment methods, deductibles, patient responsibility and potential write-offs.