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