Medical Insurance - Chapter 8 Practice Questions and Answers
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Course
PCP
Institution
PCP
Medical Insurance - Chapter 8 Practice Questions and Answers
document of eligible members of a capitated plan registered with a particular PCP for a monthly period
monthly enrollment list
payer preauthorication for elective hospital based services and outpatient surgeries
precertification...
Medical Insurance - Chapter 8 Practice
Questions and Answers
document of eligible members of a capitated plan registered with a particular PCP for a
monthly period - answer monthly enrollment list
payer preauthorication for elective hospital based services and outpatient surgeries -
answer precertification
document that modifies an insurance contract - answer rider
insurance plan, usually a PPO, that requires a large amount to be paid before benefits
begin, part of a consumer driven health plan - answer high deductible health plan
part of a standard health plan that is changed under a negotiated employer sponsored
plan - answer carve out
a company hired by a payer to evaluate the appropriateness and medical necessity of
hospital-based healthcare services - answer utilization review organization
quick reference tables for health plans - answer plan summary grid
surgical procedure that can be scheduled in advance - answer elective surgery
In a BLue Card Program, the provider's local BCBS plan - answer home plan
contractual guarantee against a participating provider's financial loss due to an
unusually large demand for higher cost services - answer stop loss provision
arrangement by which a capitated provider prepays an ancillary provider - answer
subcapitation
a vendor that processes a payer's out of network claims - answer repricer
term for the new designs of health plans created by the ACA - answer metal plan
The largest employer-sponsored health program in the United States. - answer
federal employee health benefit program
In employer-sponsored health plans, employees may choose their plan during the -
answer open enrollment period
Which laws govern the portability of health insurance? - answer COBRA and HIPPA
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