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MAT 2300 Final Review

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Across
4.nationwide federation of nonprofit health insurance companies
6.individual enrolled with BC/BS plan
8.Codes that identify specific events that determine liability for paying the claim
9.Medicaid insurance carriers that reimburse the provider for servies rendered
12.the patient authorizes the insurance carrier to send payment to the facility
16.TRICARE and CHAMPVA Dependents
19.Primary screening tool used when applying for Medicaid
22.an option available to TRICARE Standard beneficiaries
23.identifies the risks associated with exposure to specific chemicals or hazardous substances
24.individuals who coordinate care, maintain health records and make referrals for TRICARE Prime members
26.For those individuals who are age 65 and older
27.fee that is higher than usual or customary fee and can be justified by the patient's condition
29.calculation that insurance companies use to establish provider fee schedules
Down
1.aka ADSM
2.two types: partial and total
3.computerized data base of uniformed service members and family members
5.claim that clears the editing process
7.process that sends information back and forth between two or more individuals by computer linkages
10.accepts electronic claims, edits the claims, provides biller with error edit messages
11.billing the patient for amount not covered by insurance
13.name given to insurance carriers for TRICARE
14.fee provider usually charges for a given service
15.alternative to the origina fee-for-service Medicare program
17.services such providing egg crate mattresses or radiology services; are not included in the room and board charges
18.surgical procedure that is not an emergency and is scheduled in advance
20.term used to describe detailed explanation of claims denial or approval
21.designed to cover some health care costs not covered by Medicare
22.disability that can be overcome by medical treatment or retraining
25.individual who served in the US armed forces, is no longer in the services, and was honorably discharged
28.code that identifies the local or state insurance plan

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