CH-03: Interactive Exercises

insurance

policyholder,guarantor or subscriber

secondary insurance

the insurance plan that pays benefits after payment by the primary payer when a patient is covered by more than one medical insurance plan

direct provider

the provider who treats the patient

requires TOS payment

-copayments -previous balances -over limit fees -charges for self pay payments -deductibles for patients with CDHP's

HIPAA referral certification and authorization

HIPAA X12 278 transaction in which a provider asks a health plan for approval of a service and gets a response

coordination of benefits

a clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim

established patient

a patent who has received professional services from a provider or another provider in the same practice with the same specialty in the past three year

new patient

a patient who has not received professional services from a provider or another provider in the same practice with the same specialty in the past three year

assignment of benefits

authorization by a policyholder that allows a payer to pay benefits directly to a provider

referral number

authorization number given to the referred physician

referral waiver

document a patient signs to guarantee payment when a referral authorization is pending

walkout receipt

document given to a patient who makes a payment

patient information form

form completed by patients that summarizes their demographic and insurance information

encounter form

form used to summarize the treatments and services patients receive during visits

certification number

identifying code assigned when preauthorization is required

prior authorization number

identifying code assigned when preauthorization is required