1. Type of insurance that does not cover primary care, but covers costs associated with significant illness or injury, such as hospitalization or surgeries.
    Major medical
  2. Organization that provides comprehensive health care services for plan particpants at a fixed rate.
    Managed Care
  3. Provides health coverage for the categorically needy; a federal health cost assistance program.
  4. Unique 10 digit number assigned to providers to identify them on a CMS 1500 claim form.
    National Provider Identification
  5. Process of obtaining approval for a service through the individual's insurance company by establishing that it is medically necessary.
    Preauthorization/ Prior authorization
  6. Process of determining whether a service is covered under the insured person's plan.
  7. Process of ascertaining the amount the insurance carrier will pay for a specific service.
  8. A diagnosed and treated health condition that the patient had before obtaining insurance.
    Preexisting condition
  9. A plan allowing the insured person to select physicians, hospitals, and other health care services from an approved list issued by their insurance plan to provide care at a discounted rate.
    Preferred Provider Organization (PPO)
  10. A dollar amount the isured person pays for insurance coverage.
  11. The usual, customary, and resonable fees of like providers in the same geographic.
    Prevailing fee
  12. Physician contracted through a specific insurance plan to provide or to coordinate the care of all patients assigned through the insurance carrier.
    Primary Care Provider (PCP)
  13. The entity that pays the second party for the medical bills of the first party (insured ot patient) also known as the third party administrator.
    Third Party Payer
  14. Formerly known as CHAMPUS; health care benefit plans provided by the federal government, primarily for spouses and dependents of service men and women.
  15. Medical and disability insurance to cover employees in the event of a work-related injury, illness, or death.
    Workers' Compensation
Card Set
Insurance Terminology Commercial 17-31