bcbs and commercial Questions and Answers well Explained Latest 2024/2025 Update 100% Correct.
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Course
Bcbs and commercial
Institution
Bcbs And Commercial
BCBS primary claim status is determined when the patient is - covered by only one BCBS policy,
covered by both a government-sponsored BCBS plan, Covered by a non-BCBS plan that is not employer -
sponsored, Designated as the policyholder of one employer-sponsored plan and is also listed as a
depe...
BCBS primary claim status is determined when the patient is - covered by only one BCBS policy,
covered by both a government-sponsored BCBS plan, Covered by a non-BCBS plan that is not employer -
sponsored, Designated as the policyholder of one employer-sponsored plan and is also listed as a
dependent on another employer-sponsored plan
PPN provider - a provider who is signed a PPN contract) agrees to accept the PPN allowed rate ,
which generally ten percent lower than the PAR allowed rate. The provider further agrees to abide by all
cost containment, utilization and quality assurance provisions of the PPN program.
commercial health insurance - covers the medical expenses for individuals (e.g. private health
insurance) and groups (e.g. employer group health insurance
commercial claim - the patient is covered by a large employer group health plan (EGHP) and a
patient is also a Medicare beneficiary. EGHP is primary
commercial secondary coverage - if the payers for the primary and secondary or supplemental
policies are different submit a CMS-1500 claim to the primary payer
participating providers - the "blues" were pioneers in negotiating contracts with providers of care.
A participating provider is a health care provider who enters into a contract with a BCBS corporation and
agrees to
preferred provider network - a program that requires providers to adhere to managed care
provisions
nonparticipating providers - have not signed participating provider contract, and they will expect
to be paid the full fee charged for services rendered
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