Medical Terminology Crossword

Utilization management program that requires the individual or the provider to notify the insurer prior to a hospitalization or surgical procedure. The notification allows the insurer to authorize payment, as well as to recommend alternate courses of action.
Current Procedural Terminology
A dollar amount as specified in the schedule of benefits that you are required to pay at the time covered services are rendered.
The arrangement by which the insurer and the insured share a percentage of covered losses after the deductible is met.
The amount of covered expenses that must be incurred by the insured before benefits become payable by the insurer.
Most commonly defined as the determination of whether the covered person qualifies for coverage.
10-digit unique identifier issued by the National Plan Provider Enumeration System (NPPES), used to identify a health care provider to all health plans/payers.
Coordination of Benefits
A term used in COB to designate that an insurer has primary liability as determined by certain rules of order establishing such primacy. The Primary Carrier assumes its full liability toward those expenses covered under its contract.
Any illness, injury, or condition which existed prior to the issuance of a specific policy.
Written policies pertaining to clinically important and scientifically complex emerging medical technologies and new applications of established technologies.
A term used to identify physician and other medical/surgical services and respective charges.
Pertaining to care provided by a facility rather than a professional provider.
Amount in dollars met by the patient/family in a deductible plan.
The status of a covered person who receives services or supplies through a Hospital, other facility provider, physician, or other professional provider while not confined as an inpatient.
The period of time when benefit maximums, deductibles and coinsurance limits can be accumulated. Usually a calendar year, unless specifically amended.
An agreed maximum charge for a service.
Durable medical equipment
Terms used by insurers to describe medical treatment that is appropriate and rendered in accordance with generally accepted standards of medical practice.