UHC United Health Care

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Across
  1. 2. for medicines
  2. 5. Specialists, PCP's, non-delegated groups.
  3. 7. Incoming mail
  4. 8. First of the current month
  5. 9. Healthcare professionals for business only
  6. 10. they can go anywhere they want (no referral.)
  7. 13. Effective on the first of the following month
  8. 15. flat rate
  9. 18. Medically necessary services.
  10. 20. decision about Part C payment or benefits, or the discontinuation of health services that the member believes they are entitled to.
  11. 22. Deal with contracting networking
  12. 23. Hospital, nursing, home health, inpatient
  13. 24. for patients, members, and employees to have access to health related sites
  14. 25. shows prior authorization, denials, review process
Down
  1. 1. used to look up specific information CMS has on file for a caller's Medicare benefits.
  2. 3. Accepts PFFs plan Medicare eligible.
  3. 4. has to have a referral
  4. 6. you pick one primary care physician who will coordinate all your health care services. Your doctor keeps track of all your medical records and provides routine care. In order to see a specialist, you’ll need a referral from your primary care physician
  5. 11. Process of determining and processing a claim in conjunction with another insurance coverage.
  6. 12. is issued by the payer, giving the provider the go-ahead to perform the necessary service.
  7. 14. Primary Care Physicians
  8. 16. Organization determination is under this part
  9. 17. percentage of costs
  10. 19. you can go to any health care professional you want without a referral, inside or outside of the plan network.
  11. 21. process which gives a contracting medical group or provider the authorization and responsibility to perform certain functions.