Memory Medical Insurance Terminology MatchVersión en línea Test your knowledge of medical insurance terms with this fun memory card game! por Lythia a large set amount of money the patient must pay before the insurance will pay. renews every year. out-of-network Coinsurance Medicare D the set amount a patient owes at every visit professional or group not contracted with an insurance carrier Network provider Premium the set amount paid by the patient or employer every month, quarter, or year for the insurance coverage the bill sent to the TPP for reimbursement for services rendered Coordination of Benefits - determination of which isurance plan is primary, secondary or tertiary Deductible COB for minors covered by both parents in-house. parent with birthday 1st in the year is primary Copayment percentage of total charges for a service the patient must pay per insurance benefits after the claim has been processed. birthday rule professional contracted with the insurance carrier add-on drug coverage for disabled or 65+ yo patients COB Claim the subscriber or patient receiving the benefits of the insurance policy a participating provider contracted with insurance to accept allowable amounts only for services rendered PAR required approval for services or medications from insurance after providing supporting documents. Not a guarantee of payment medical insurance for dependants of military disabled or killed in service. gatekeeper CHAMPVA Medicare C CMS-1500 explanation of benefits - sent to the patient showing all claims filed for services to their insurance EOB universal claim or billing form for all outpatient services beneficiary PCP for MCO plans requiring patients to see PCP for all referrals managed care plan for Medicare requires copay Prior Authorization Medicare A WC MCO plan with PCP, copay with out-of-network benefits at higher out of pocket costs managed care plan, most restrictive with PCP & copays & no out-of-network benefits Workers' Compensation - Employer coverage for injuries/illness obtained on the job ABN Hospital coverage for 65+, disabled patients for free HMO electronic remittance advice sent to the provider for claims reimbursement details and denials Medicare B Tricare POS fee-for-service reimbursement method paying for each allowed service provided ERA add-on paid coverage for 65+ or disabled patient for additional premiums PPO Medicare required form to be completed before possibly non-covered services are provided insurance for military members and family MCO plan combining HMO & PPO with copay, out-of-network coverage & self-referrals. Least restrictive
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