Define the terminology necessary to understand and submit medical insurance claims.
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| 14312376096 | 5 Examples of Medical Insurance Coverage | Medicaid Military Medicare Point Of Service (POS) Preferred Provider Organization (PPO) | 0 | |
| 14312389907 | The Steps Involved When Screening Patients for Insurance. | Name Date Of Birth Name of Primary Insured Social Security Number Insurance Carrier ID Carrier Group Number | 1 | |
| 14312417844 | The Importance of Obtaining Referrals and PreAuthorization | A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. | 2 | |
| 14312429351 | Referral Management | A system is a unique and powerful tool for health providers to keep track of their patient referrals throughout the care continuum. Its main goal is to improve and streamline communication among primary care physicians, specialists, and any other health providers involved in a patient's care. | 3 | |
| 14312437440 | How do Referrals Work? | If your specialist recommends that you see another specialist, you'll need to coordinate a new referral with your primary care physician for that care. Some Blue Care Network plans let you self-refer, which means you can see any doctor you want without a referral from your primary care physician. | 4 | |
| 14312449656 | PreAuthorization | Authorization, also known as precertification, is a process of reviewing certain medical, surgical or behavioral health services to ensure medical necessity and appropriateness of care prior to services being rendered. The review also includes a determination of whether the service being requested is a covered benefit under your benefit plan. Authorizations are only required for certain services. Your physician will submit authorization/precertification requests electronically, by telephone, or in writing by fax or mail. If approved, an authorization number is then generated by Capital Health Plan and is available to you via CHPConnect. If the requested service is not authorized, the member and provider are notified in writing with the specific reasons for the denial and appeal rights. | 5 | |
| 14312456922 | CHAMPVA | Civilian Health and Medical Program of the Department of Veterans Affairs a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. | 6 | |
| 14312461290 | CHAMPUS | Civilian Health and Medical Program of the Uniformed Services Tricare (styled TRICARE), formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), is a health care program of the United States Department of Defense Military Health System. | 7 | |
| 14312468883 | Workers Compensation | a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue their employer for the tort of negligence. | 8 | |
| 14312488258 | The impacts of HIPAA requirements related to insurance and the release of patient information. Legal and ethical issues related to medical insurance | Health care professionals practice in an environment that is complex, with many regulations, laws and standards of practice. Performing an abortion is legal but may not be considered ethical by other health care professionals or members of the public at large. Other ethical dilemmas arise at the end of life, when a decision must be made to turn off life-support machines and allow death to occur. Other common ethical issues a health care professional might face are confidentiality, relationships with patients and matters related to consent, especially in the treatment of minors. | 9 | |
| 14312497212 | Understanding the process of procedures and diagnostic coding | The translation of services rendered into numeric value | 10 | |
| 14312504309 | HSA (Health Savings Account) | Health spending accounts might be for you. You can use these accounts for qualified medical expenses, such as deductibles and copays. Health spending accounts come in three forms: Health savings account, or HSA. Health reimbursement arrangement, or HRA. | 11 | |
| 14312512562 | FSA (Flexible Spending Account) | A health flexible spending account (FSA) is part of your benefits package. This plan lets you use pre-tax dollars to pay for eligible health care expenses for you, your spouse, and your eligible dependents. Here's how an FSA works. Money is set aside from your paycheck before taxes are taken out. | 12 |
