Claims Basic's Word Search
Type
Word Search
Description

TAX IDENTIFICASTION NUMBER
DURABLE MEDICAL EQUIPMENT
COORDINATION OF BENEFITS
EXPLANATION OF BENEFITS
MAXIMUM OUT OF POCKET
PREAUTHORIZATION
EFFECTIVE DATE
COINSURANCE
DEDUCTIBLE
COPAYMENT
HIPAA
ERISA

Reading A Paycheck Stub Crossword

Reading A Paycheck Stub Crossword
Type
Crossword
Description

Lists paycheck deductions as well as other important info
The employee's full name, address, and social security #
Total amount of money earned during the pay period before deductions
total amount of money left after all deductions are taken out
The amount of money deducted from the gross pay for taxes, medicare, or benefits
The % deducted from an individual's paycheck to assist in funding the state
Federal Insurance Contribution Act
Nation's retirement program, provides retirement income for the elderly and pays disability
The nation's healthcare program for the elderly and disabled
The amount an employee contributes each pay period to a retirement plan
The amount taken from your paycheck for medical benefits
The amount by laws for employers to withhold from earned wages
Totals of all deductions from January 1st to the day of the pay period
Length of time for which an employee's wages are calculated
Compulsory charges imposed on citizens by local, state, and federal governments
Collects federal taxes, issues regulations, and enforces tax laws written by the U.S.
Employers directly deposit employee's paycheck into the employee's authorized account
Electronically carries the employee's net pay
Used to determine the amount of federal taxes withheld from the paycheck
A person who relies on the tax payer for financial support

Healthcare Vocabulary Crossword

Healthcare Vocabulary Crossword
Type
Crossword
Description

A contract with a company where the subscriber pays a regular premium in exchange for a defined set of benefits
Reffered to as family doctor/PCP this person administers routine and preventive care, and makes referrals for specialty services when needed.
A provider who focuses on one area of medicine. Like a cardiologist or neurologist
A contracted, pre-determined dollar amount insurance company requires a patient to pay for a particular medical service. (It requires patients to pay a small amount upfront to deter people from seeking medical care that may not be necessary.)
The contracted rate a health insurance company will pay toward a specific medical service.
A contracted, pre-determined percentage of the allowable charge that a patient is required to pay for a particular medical service (after the deductible is met and before the out-of-pocket maximum is met).
A pre-determined annual amount patient must pay before insurance begins to cover.
Annual maximum amount patient is required to pay for in-network medical services per his/her insurance plan contract (typically, copay + coins + deductible)
The person who is responsible for payment of the monthly premium, or whose employment is the basis for the coverage.
A person entitled to health insurance benefits under the subscriber’s plan.
Insurance Company
A specific package of benefits negotiated between the company and the employer.
Dates during which the insurance plan is active.
Explanation of Benefits is a statement from the insurance company that details payments and adjustments made for services. EOBs go to both the provider and the patient.
/Response from the insurance company that states no payment will be made. (service could be not covered by the insurance plan, or the insurance company may need more information.)
The order in which the claim is sent to insurance companies. If patient has more than one insurance plan, we must determine which insurance should be billed primary, secondary, etc. Primary: the first insurance company designated to pay toward their allowable charges. Secondary: the second insurance company designated to pay toward their allowable charges.
The pathway a patient takes from one provider to another. Referrals may be required by insurance before a patient can be seen by the other provider.
The process whereby a physician must obtain insurance approval before a patient receives certain treatment or drugs (study, test, procedure, surgery.)

2017 Benefits Open Enrollment Word Search

2017 Benefits Open Enrollment Word Search
Type
Word Search
Description

High Deductible Health Plan
Preferred Provider Network
Evidence of Insurability
Prescription Drug Plan
Out Of Pocket Expenses
Flexible Spending Plan
Health Savings Account
Out Of Pocket Maximum
Wellness Incentive
Annual Deductible
Plan Eligibility
Benefit Advocate
PreCertification
Coinsurance
Copayment

Insurance Word Search

Insurance  Word Search
Type
Word Search
Description

Commercial Insurance Plan
Pharmacy Benefit Manager
Blue Cross Blue Shield
Medical Doctor Office
Medicare Part D Plan
Formulary Exception
Healthcare Provider
Prior Authorization
Specialty Pharmacy
Out of Pocket Max
Registered Nurse
Benefit Cap
Coinsurance
Non Covered
Deductible
Start Form
Provider
Covered
Patient
Dosage
Copay
Payer

Health Care Industry Word Search

Health Care Industry Word Search
Type
Word Search
Description

Activities of Daily Living
durable medical equipment
durable power of attorney
electronic health record
home medical equipment
disease management
Ancillary services
fee for service
benefit period
eligibility
coinsurance
comorbidity
beneficiary
deductible
Assignment
Ambulatory
copayment
dementia
charge
claim
cost

Benefits & Eligibility Key Terms Crossword

Benefits & Eligibility Key Terms Crossword
Type
Crossword
Description

Time period in which the benefits renew beginning January 1st.
Is an area in Facets that is used to provide a quick reference of the patients’ benefits. Access to the patients benefit language is done through Benefit Summary.
A type of contract between a large group (100 + lives) and WPS. The group maintains a money account in which WPS has access to in which the medical claims are paid from. An ASO group pays WPS to administer their benefits and to pay the medical claims for them. These are commonly referred to as self-funded groups.
A request by an individual (his or her provider) to an individual’s insurance company for the insurance company to pay for services obtained from a health care professional.
The process of an analyst reviewing claims for medical necessity, frequency, etc.
Percentage that the insurance company pays for services rendered to the member.
Specific dollar amount that a member must pay for every visit.
The amount that a member must pay before the insurance company will start paying for services.
A type of plan where there is only one benefit level and referrals are required if the patient is seen by an out of network provider. If a referral is not obtained, the services will not be covered.
A system which holds the eligibility data base and the claim system
A prescription legend drug sold by the pharmaceutical company or other legal entity other than the one holding the original United States patent for that prescription legend drug.
A privacy rule which protects the privacy of individually identifiable health information.
Type of managed care plan that requires members to use in-network providers for all their health care needs. There is no coverage for services received from providers who are outside of the HMO’s network, except for emergency care.
A group of doctors, hospitals and other providers contracted to provide services to insured individuals for less than their usual fees. Provider networks can cover large geographic markets and/or a wide range of health care services. If a health plan uses a preferred provider network, insured individuals typically pay less for using a network provider.
Total amount that WPS will pay for claims over the lifetime of the policy.
A medical condition or pre-existing condition noted in the application process and added to the policy as a waiver by Underwriting. The waiver is signed by the member and is part of policy. Benefits will not be available for these conditions unless waiver is removed.
Individual Medicare supplement polices are designed to supplement the benefits available under the original Medicare program. Medicare supplement policies pay a percent of Medicare approved charges that Medicare does not pay. Some Medicare supplement policies will pay for benefits for services after Medicare will no longer pay.
A group of providers who have agreed to provide services at a contracted rate.
The date a policy goes into effect.
Describes a provider or health care facility which is not part of a health plan’s network. Insured individuals usually pay more when using an out-of-network provider, if the plan uses a network.
Total amount that a member would pay in a calendar or plan year for services rendered to them.
Primary Care Physician
HIPAA prohibits the sharing of PHI without written permission of the patient. PHI includes but is not limited to medical diagnosis, medical treatment, eligibility for a health plan, health plan premium payments, and health care claim status. When PII is linked with health condition, treatment or payment of healthcare, it becomes PHI in the hands of a covered entity like WPS.
This was created by the federal government to prevent identity theft by improving information security. PII is information that can be used to uniquely identify, contact, or locate a single person or can be used with other sources to uniquely identify a single individual. PII includes but not limited to: Full name, tax identification number, driver’s license number, credit card number, date of birth, address, age, race or gender, and salary or job description.
A type of plan where there are two or more benefit levels in which a claim can be paid under. A PPO has a network of preferred providers. If a patient goes to a provider not in their network, the claim will be paid at the lesser level of benefit, called out of network or Tier 2. Typically, a PPO does not have a referral option but can; however, referrals are not required.
A request for a service to be reviewed for the medical necessity prior to the patient receiving the service. This review is recommended vs. required.
A request for an inpatient service prior to the admission.
The amount of money you and/or your employer pays in exchange for insurance coverage.
Certain services require a medical necessity review prior to the service being provided based on the patient’s benefit language. Some benefit language also indicates that if the medical necessity review is not done prior to the service being provided, then a penalty or a benefit reduction will be applied to that service.
Any person or entity providing health care services, including hospitals, physicians, home health agencies and nursing homes. This is an inclusive term to define any person or entity that delivers medical care.
A type of a contract in which WPS is paid a monthly premium for our services. A risk plan can be a small group, a large group or an individual plan.
Certain benefits required to be covered in commercial health insurance plans by the State.
Owned and maintained by other companies and WPS rents the use of these networks to offer more providers to our members .
An online resource of corporate wide information including individual departmental information.

Healthcare Vocabulary Crossword

Healthcare Vocabulary Crossword
Type
Crossword
Description

The pathway a patient takes from one provider to another. Referrals may be required by insurance before a patient can be seen by the other provider.
Dates during which the insurance plan is active.
A contract with a company where the subscriber pays a regular premium in exchange for a defined set of benefits
The order in which the claim is sent to insurance companies. If patient has more than one insurance plan, we must determine which insurance should be billed primary, secondary, etc. Primary: the first insurance company designated to pay toward their allowable charges. Secondary: the second insurance company designated to pay toward their allowable charges.
The contracted rate a health insurance company will pay toward a specific medical service.
A provider who focuses on one area of medicine. Like a cardiologist or neurologist
A pre-determined annual amount patient must pay before insurance begins to cover.
The person who is responsible for payment of the monthly premium, or whose employment is the basis for the coverage.
The process whereby a physician must obtain insurance approval before a patient receives certain treatment or drugs (study, test, procedure, surgery.)
A specific package of benefits negotiated between the company and the employer.
Response from the insurance company that states no payment will be made. (service could be not covered by the insurance plan, or the insurance company may need more information.)
Insurance Company
A contracted, pre-determined dollar amount insurance company requires a patient to pay for a particular medical service. (It requires patients to pay a small amount upfront to deter people from seeking medical care that may not be necessary.)
Reffered to as family doctor/PCP this person administers routine and preventive care, and makes referrals for specialty services when needed.
A contracted, pre-determined percentage of the allowable charge that a patient is required to pay for a particular medical service (after the deductible is met and before the out-of-pocket maximum is met).
Annual maximum amount patient is required to pay for in-network medical services per his/her insurance plan contract (typically, copay + coins + deductible)
Explanation of Benefits is a statement from the insurance company that details payments and adjustments made for services. EOBs go to both the provider and the patient.
A person entitled to health insurance benefits under the subscriber’s plan.

Medical Insurance Word Search

Medical Insurance Word Search
Type
Word Search
Description

pre existing condition
health care provider
health maintenance
medical insurance
health insurance
medical expenses
coverage limits
out of pocket
peace of mind
co insurance
doctor visit
medical bill
prescription
health care
health plan
out patient
specialists
co payment
deductible
exclusions
in network
percentage
prevention
dependent
indemnity
benefits
Medicare
referral
balance
illness
insured
insurer
maximum
premium
policy
claim

Healthcare Basics Word Search

Healthcare Basics Word Search
Type
Word Search
Description

institutional
participating
professional
timelyfiling
coinsurance
subrogation
capitation
commercial
deductible
enrollment
healthcare
outpatient
copayment
dependent
diagnosis
insurance
inpatient
medicaid
medicare
modifier
provider
tertiary
allowed
billing
insured
network
quality
claims
member
office
audit
HIPAA
plan

Medical Billing Terms Word Scramble

Medical Billing Terms Word Scramble
Type
Word Scramble
Description

Account
Write Off
Workers Comp
Allowed Amount
Appeal
Unbundling
Capitation
Billing Cycle
Managed Care Plan
Outpatient
Group number
Guarantor
Healthcare Provider
Claim
Deferred
Patient Responsibility
Protected Health Information
referral
Self Pay
Ancillary Services
Authorization
Coding
Co-Insurance
Subscriber
Remittance
Revenue Code
Term Date
Timely Filing
Aging
Deductible
Contractual Adjustment
Coordination of Benefits
Bill Date