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Insurance

Horizontales
Plans sold on government exchanges.
Health insurance for veterans who were injured or killed in the line of duty. Covers veterans, spouses and dependents. Also called Civilian health and medical plan
Health insurance for children 0-17 who's families earn above the threshold for medicaid but not enough for private insurance.
10 digit code used to identify providers
Individual paying for insurance
A notice given to a patient by the insurance company detailing what benefits were received and billed
Claims submitted electronically
Amount a patient must pay before insurance coverage begins
A company that provides scrubbing services for claims before submission to insurance
Government funded insurance plan for citizens 65 years of age and older. Contains parts A-D.
Allows employees injured in the workplace due to a work-related task to be covered, injury must be reported and filed
Plans sold directly by health insurance company or through a third party broker
Private health insurance plan which requires a PCP. You can see out of network providers but a referral is required.
Verticales
A way to determine the primary coverage when a patient is double covered
A fixed amount paid by a patient for a specified visit
A fixed percentage paid by the patient after the deductible has been met
Reviewing services prior to provision to determine medical necessity
Additions to health insurance that include dental, vision, gap, and critical illness
Law passed in 2010 to make health insurance more affordable. Prevents health insurance from denying coverage of pre-existing condition
Payment plan where insurance pays providers on a per member per month basis
Government health insurance for active military service personnel
A system that allows data to be exchanged electronically which results in faster payment
Standard form used by offices to file claims
Government funded health insurance for lower income families and individuals.
Act that allows providers to manually submit claims on a paper form rather than electronically for special reasons
Allows claims to be tracked faster and status to be checked regularly