Type
Crossword
Description

Member not happy with the denial and wants the claim reviewed. Appeals
System used to look up previous claims. Argus
Action of looking over the claim and determin if it is approved or denied. Review
The act of having fun at work. engagement
The system that generates daily schedules. Verient
Non Humana associates that assist with members and claims. vendors
Case number for prior authorizations. EOC
Area that houses all documents. Mentor
Team that handles medical claims. MIT
Team that approved or denies cases based on clinical rationale, policy and CMS guidelines. Pharmacists
Pay members back for their purchase. reimbursement
Member calls for this when they need medication before vacation. It is a vacation ... override
The system that we work out of the most. PAHub
Queue that generates a decision letter. Notifications
Area where our most recent new hires were hired into. callcenter
One of our vendor sites. Jamaica
Means to speed up the process. expidited
Tool member uses to contact HCPR. telephone

Pharmacy Week Puzzle Crossword

Type
Crossword
Description

Pharmacy Network National
Low cost alternative Generic
Online claim approval Adjudication
Brand Name Zithromax Azithromycin
Medication for Alzheimers Namenda
President of PerformRx Tegenu
Our PBM PerformRx
Pharmacist designation RPH
Pharmacy Contact Callcenter
Class of drugs Specialty
Our Claims Processor Argus
Contracted pharmacies Network
Brand Name Omeprazole Prilosec
Needs Approval Prior Authorization
Where Prescriptions are filled Pharmacy
Handles our newsletter Marketing
Review of Pharmacy claims Audit
Inhaler for Asthma Proair
Agreement to provide services Contract

U.S. Government Crossword

Type
Crossword
Description

a politically organized body of people usually occupying a definite territory state
the powers shared by the federal and state governments concurrent powers
the powers that the constitution neither gives to congress nor denies to the states reserved powers
the powers given to Congress rather than to the states delegated powers
people who are chosen to speak and act for their fellow citizens;elected by a state Senators
people who are chosen to speak and act for their fellow citizens; elected by a district Representatives
relating to a crime criminal cases
advisors to the President cabinet
two house legislature bicameral
a case relating to the rights of citizens civil case
interprets laws to see what they mean and whether they are constitutional Judicial Branch
a system that allows each branch of government to limit the powers of the other two checks and balances
a trial where a group of tweleve people listens to the evidence and decides who wins the case jury trial
listed powers for Congress; the great laundry list of congressional chores enumerated powers
the House of Representatives accusing the President of wrongdoing impeach
a group of lawmakers which is divided into 2 smaller groups Congress
action by a President refusing to approve a bill passed by Congress veto
law making branch Legislative Branch
an idea for a law that has been written down bill
more than half majority
executes or carries out laws Executive Branch
less than half minority
there is no jury so the judge gives the verdict bench trial
asking an appellate court to review a case appeal

Insurance Billing/Terminology Crossword

Type
Crossword
Description

The process of establishing the need for a service? medical necessity
A provider's list of charges for services provided. fee schedule
The amount the insurance company determines to be customary price for a service, usually less that what the provider charges? allowed amount
Fixed percentages of the cost of a service paid by the patient or a second insurance? coinsurance
Fixed amount paid by the patient at the time of service? copayment
Payment for health insurance policy? premium
A complete correct claim or a claim with no errors? clean claim
The primary provider who arranges for specialists or hospitalizations? gatekeeper
The medical insurance policy that is billed first? primary policy
National Provider Identification NPI
Centers for Medicare and Medicaid Services CMS
Managed Care Organization MCO
Diagnosis Related Group DRG
Medigap MG
Advance Beneficiary Notice ABN
Coordination of Benefits COB
Primary Care Provider PCP
Fee-For-Service FFS
Common for insurance to require approval for? elective procedures
Used to identify a procedure on a claim form? CPT
Family members of the insured are called? dependents

Review Crossword

Type
Crossword
Description

Tylenol is what kind of drug Brand
Acetaminophen is what kind of drug generic
I have to pay all of it because my insurance doesn't cover it cashandcarry
Her prescription plan pays, which part is covered partd
Im written just like the doctor wanted daw
I come in tablets, capsules, and some times injectables dosageform
I come together and not commercially available Compounds
What is NDC nationaldrugcode
Preferred list of medication that are on the plan formulary
I exceeded quantity therapy allowed MDl
Humana Pharmacy offers this to its members Mailorder
I might call if your taking high medication myb
try taking a lower cost drug steptherapy
otc means overthecounter
Im asking you to cover me priorauthorization
CVS is a ________ Pharmacy retail
I treat chronic conditions specialtymedication
How much active ingredient I measure strength
_______ exception Tier
Where do I look for the correct answer Mentor
Where I go to find pharmacy claim Argus
Where to look up estimated copay rxlookup
What tap used to fill orders rightsource
Ordering Management System use to be called epost
Sub Tab for putting in member's Humana ID Newcontact
We want to give the member the ___ experience Perfect
Place to sign me up Webregistry
GCN is _____ ______ number generic code

Mock Trial Vocabulary Crossword

Type
Crossword
Description

to clear from charge or accusation Acquit
to hear and settle a case Adjudicate
An act that violates the law Crime
Written declaration made under oath Affidavit
An assertion that must be proved with evidence Allegation
A defendant’s defense against charges Answer
Transferring a case to a higher court for review Appeal
Hears court appeals and reviews decisions Appellate court
Objecting that admits facts of an opponent’s argument that denies they sustain pleading Demurrer
To call the accused to answer the charge Arraignment
Someone’s specific attorney Attorney At Law
Responsible for the case Attorney of record
Assessing the cause of death and examining the cadaver Autopsy
Money in exchange for release of the arrested, in guarantee that they’ll come to trial Bail
Court attendant who keeps order Bailiff
Responsible of proving a charge or allegation Burden of Proof
Facts or evidence in support of claim Case
Hall for trials and court Chambers
Laws of a nation dealing with rights of citizens Civil Law
Summing up important arguments, after seeing evidence Closing Argument
Filed in court against someone, by a plaintiff Complaint
When someone is officially guilty of a crime Conviction
Someone who investigates suspicious deaths Coroner
One who gives advice on legal matters Counsel
Group of people who make decisions about legal cases, and the time when this happens Court
When the accused is charged and judged Criminal action
System for those who commit (or are accused of) crimes Criminal law
Witness is interrogated/extends testimony Cross Examination
Award as compensation for loss/injury, usually money Damages
The accused party Defendant
Questioning a witness Direct Examination
Fair treatment of anyone in court Due Process Of Law
Anything giving information on the case(documents, testimony, items) Evidence
Document or article that is inspected; a form of evidence Exhibit
Crime that is more serious than a misdemeanor Felony
Formal charge for crime Indictment
Court order that prohibits a party of from specific action Injunction
Witnesses must leave the room when someone is appealing to the judge Invoke the Rule
One who hears and decides on court of law Judge
Right to interpret and apply law Jurisdiction
A jury of 12-23 people Jury Grand
Sits at civil and criminal cases Jury Petit

Judicial Branch Crossword

Type
Crossword
Description

People or things that can prove one side’s version of what happened evidence
The document that created the judicial branch Constitution
Asking an appellate court to review a case appeal
Type of case about someone accused of committing a crime criminal
Court system that deals with United States laws federal
Court system that deals with state laws state
Type of case relating to peoples’ rights civil
Group of people that decides a case after hearing the evidence jury
Number of justices on the Supreme Court nine
the court of last resort supreme court
The Supreme Court’s power to decide what is constitutional judicial review
The lowest court in the federal system district court
minority opinion dissenting
Term used to protect the rights of individuals due process
False accusations in writting libel
An opinion in the supreme court that emphasizes the majority concurrent
Practice of spying for a foreign power espionage
The review by the supreme court of a decision made by a lower court certiorari
Supreme court Chief Justice John Roberts
The right to remain silent self-incrimination

Basics of Health Insurance Crossword

Type
Crossword
Description

An established schedule of fees set for services performed by providers and paid by the patient fee for service
protection in return for periodic premium payments that provides reimbursement of expenses resulting from illness or injury Health insurance
the sum of money paid at the time of medical service; it is a form of coinsurance copayment
provision frequently is found in medical insurance policies whereby the policyholder and the insurance company share the cost of covered losses in a specified ratio coinsurance
Civilian Health and Medical Program of the Veterans Administration known as CHAMPUS
states that when an individual is covered under two insurance policies, the insurance plan of the policyholder whose birthday comes first in the calendar year (month and day, not year) becomes the primary insurance. birthday rule
A term used in managed care for an approved referral authorization
a payment method used by many managed care organizations in which a fixed amount of money is reimbursed to the provider for patients enrolled during a specific period of time, no matter what services were received or how many visits were made. Capitation
a letter or statement from Medicare that describes what was paid, denied, or reduced in payment. EOMB
Pays expenses involved in the care of the teeth and gums Dental care
Protects a person in the event of a certain type of accident, such as an airplane crash Special risk insurance
Often includes benefits for medical expenses payable to individuals who are injured in the insured person’s home or during an automobile accident Liability insurance
Covers a continuum of maintenance and health services for chronically ill, disabled, or mentally retarded individuals Vision care
Provides payment of a specified amount on the insured’s death Life insurance
Pays the cost of all or part of the insured person’s hospital room and board and specific hospital services Hospitalization
a review of individual cases by a committee to make sure services are medically necessary and to study how providers use medical care resources utilization review
40. An insurance term used when a primary care provider wants to send a patient to a specialist referral
periodic (monthly, quarterly, or annual) payment of a specific sum of money to an insurance company for which the insurer, in return, agrees to provide certain benefits premium
person who pays a premium to an insurance company and in whose name the policy is written in exchange for the insurance protection provided by a policy of insurance policyholder
a general practice or nonspecialist provider or physician responsible for the care of a patient for some health maintenance organizations gatekeeper

Judicial System Crossword Puzzle

Type
Crossword
Description

Judicial official who hears cases Judge
Group of citizens who decide a legal case Jury
Highest court in the land Supreme Court
Number of justices on the Supreme Court nine
Where the Supreme Court gets its authority Constitution
Local courts that deal with big cases Circuit Courts
Local courts that deal with smaller cases District Courts
People under age 18 Juvenile
Type of court that settles financial disputes Small Claims
Person who keeps track of financial transactions Clerk
To ask a higher court to review your case Appeal
Decision of a judge or jury Verdict
Guidelines set by previous legal decisions Precedent
Branch that deals with interpreting the law Judicial

DEBATE TERMS Crossword

Type
Crossword
Description

Argues in favor of the resolution affirmative
Uses evidence and reasoning to support claims argument
Statement that a debater supports or refutes with evidence and reasoning claim
Speech presenting a debater's basic arguments for or against the resolution constructive
Another word for "claims" contentions
When a member of one team questions an opposing team member cross examination
Process of formally arguing a resolution against an opposing team debate
Matches two teams against each other, one affirming and one opposing the resolution debate format
Explanations of terms stated in the resolution definitions
Information used to support a claim, such as a testimonial evidence
Bad reasoning resulting in an unsound argument fallacy
Taking notes during a debate to prepare for CX flowing
Individual who listens to a debate and decides the winner Judge
Argues against the resolution negative
Using analysis to connect the evidence to the claim being made reasoning
Speech that challenges and defends arguments introduced in a constructive speech rebuttal
process of attaching an opponent's arguments refutation
The topic or claim being debated resolution

Supreme Court Crossword

Type
Crossword
Description

the judicial system used in the United States. It allows opposing parties to present their legal conflicts before an impartial judge and jury Adversarial System
a court in which appeals from trial court decisions are heard. Appeals Court
an additional written court opinion in which a judge or judges agree(s) with the decision reached by the Court, but for reasons other than those stated in the majority opinion. Concurring Opinion
the person against whom a claim is made. In a civil case, the person being sued. In a criminal case, the person charged with committing a crime. Defendant
In a trial or appeal, the written opinion of the minority of judges who disagree with the decision of the majority. Dissenting Opinion
the trial courts of the federal court system. They have jurisdiction over almost all federal cases, both civil and criminal. Federal District Court
the view that Supreme Court justices should (re)interpret the Constitution to serve the justices' opinions of the needs of contemporary society. Judicial Activism
the view that Supreme Court justices should not interpret the Constitution according to personal philosophies and should stick to the original meaning of the document. Judicial Restraint
the power, right, or authority to interpret and apply the law Jurisdiction
the power to hear a case for the first time Original Jurisdiction
the ability to exercise judicial review in different courts, at the same time, within the same territory, and over the same subject matter Concurrent Jurisdiction
a formal application by a party to have a lower-court decision reviewed by the U.S. Supreme Court, which has discretion to approve or deny any such application. Petition for Certorari
In a civil case, the injured party who brings legal action against the alleged wrongdoer. Plaintiff
the state or federal government's attorney in a criminal case. Prosecutor
court decision on a legal question that guides future cases with similar questions Precedent
the minimum number of members of an assembly that must be present to make a meeting valid Quorum
permits four of the nine Supreme Court justices to grant a writ of certorari (accept the petition for certorari) to prevent a majority of the Court from controlling the Court's docket Rule of 4
highest state court, has appellate jurisdiction, funnels cases to U.S. Supreme Court unless only state laws have been violated State Supreme Courts
courts that listen to testimony, consider evidence, and decide the facts in a disputed situation Trial Courts
courts that oversee reservations in the U.S., including both federal and tribal law Tribal Courts
screening process in which opposing lawyers question prospective jurors to ensure as favorable or as fair a jury as possible. Part of jury selection. French: "to speak the truth". Voir Dire