Across
- 1. An ______ is a formal request to have a decision made by the insurance company reviewed and reconsidered.
- 3. Which federal program requires strict marketing compliance and pre-approved materials for its health plan promotions?
- 6. A limited-time window when individuals can enroll in or make changes to their health insurance plan without a qualifying event (2 words).
- 8. _________ providers have agreed to provide healthcare services to members at pre-negotiated rates (2 words).
Down
- 2. A ______ claim means it's not yet approved or denied—more documentation or clarification is needed before a final decision can be made.
- 4. The __________ review is a real-time review of a patient's care while they are actively receiving treatment (usually during inpatient stays)
- 5. _________ use statistical models and data analysis to estimate future healthcare costs, evaluate risks, and determine how much premiums should be to ensure financial stability for the insurance company.
- 7. ____ Rating System is used by CMS to assess Medicare Advantage and Part D plans on quality, outcomes, satisfaction, and compliance metrics.