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