Bcbs basic coverage - Study guides, Class notes & Summaries

BCBS chap 13 Exam Questions with All Correct Answers BCBS basic coverage - Answer-Hospitalization Diagnostic service X rays Surgical fees Assistant surgeon fees Obstetric Intensive care Newborn care Chemo BCBS major medical - Answer-Office visits Outpatient non surgical Physical and occupational therapy Purchase of durable medical equipment Mental health visits Allergy testing and shots Prescription drugs Private duty nurse Dental care for accident injury Blue cros...

Which is required of outpatient physical, occupational, and speech therapy services as part of an OPAP? a. preadmission certification b. precertification c. preadmission testing d. prospective review - precertification Which phrase is located on a Federal Employee Program plan ID card? a. Family, High Option Plan b. Preferred Provider Organization c. Office of Personnel Management d. Government-Wide Service Benefit Plan - Government-Wide Service Benefit Plan Which is a program that req...

BCBS indemnity coverage is characterized by certain limitations, including - hospital-only or comprehensive hospital and medical coverage One of the requirements that a participating provider must comply with is to - make fee adjustments for the difference between amounts charged to patients for services provided and payerapproved fees. Which is a program that requires providers to adhere to managed care provisions? - preferred provider network (PPN) One of the expectations that a nonparti...

One of the requirements that a participating provider must comply with is to 1) Make fee adjustments for the difference between amounts charged to patients for services provided and payer-approved fees. 2) Write off deductible and copay/coinsurance amounts and accept as payment in full the BCBS-allowed fees. 3) Maintain a provider representative department to assist with billing and payment problems for submitted claims. 4) Purchase billing manuals and newsletters published by the payer a...

If you go outside of your network the member is responsible for ______% of the payment - 100 __________________ plan are normally selected by individuals who do not have access to a group plan or are a small business with many employees - Fee-for-service __________ corporations are charitable, educational, civic or humanitarian organizations whose profits are returned to the program of the corporation rather than distributed to shareholders and officers of the corporation - non-profit Blue...

For-profit corporations - This corporation pay taxes on profits generated by the corporations enterprises and pay dividends to shareholders on after-tax profits. individuals who don't have access to group plans and small business employers. - BCBS fee-forservice or traditional coverage is selected by.. Nonprofit corporations - Charitable, educational, civic, or humanitarian organizations whose profits are RETURNED to the corporation rather than distributed to shareholders and officers of th...

BCBS HAS A MANDATORY SECOND SURGICAL OPINION(SSO) REQUIREMENT NECESSARY WHEN A PATIENT IS CONSIDERING ELECTIVE, NON EMERGENCY SURGICAL CARE. THEINITIAL SURGICAL RECOMMENDATION MUST BE MADE BY A PHYSICIAN QUALIFIED TO PERFORMTHE ANTICIPATED SURGERY. IF A SECOND SURGICAL OPINION IS NOT OBTAINED PRIOR TO SURGERY, THE PATIENT'S OUT OF POCKET EXPENSES MAY BE ________. - INCREASED BLUE CROSS BLUE SHEILD PLANS ORIGINALLY COVERED ONLY HOSPITAL BILLS AND BLUE SHEILD PLANS COVERED FEES FOR PHYSICIA...

what is the percent that a patient pays each time they recieve services, can vary from ins. to ins. and plan to plan - co-insurance what type of organization must pay taxes on the profits and then distributes a percent to all share holders? - for-profit corporation what year did BC and BS combine personnel under the leadership of a single president, responsible to both boards of directors - 1977 what year did BC and BS merge into a single corporation called BlueCross BlueShield Association...

rider - What is a special clause in an insurance contract that stipulates additional coverage over and above the standard contract? preferred provider network - What is a program that requires providers to adhere to managed care provisions? obtain payment for the full fee charged - One of the expectations that a nonparticipating provider has is to ____ for services rendered. suitcase - The plan ID card for a subscriber who opts for BCBS's Healthcare Anywhere PPO coverage uniquely contain...

What is a benefit to employers when offering medical benefits to their employees? Federal income tax advantages Which of the following apply to group health plans? Group health plans (GHP) Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:02 / 0:15 Full screen Riders are also called _____. options An employer may do which of the following during negotiations to change benefits to a group policy? Omit a specific benef...