Which Is Considered A Service Reimbursed By Bcbs Major Medical Coverage?

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Health Insurance today Chapter 11,

Question	Respond
A well defined set of specific, clinically appropriate services, which include ongoing brusk-term treatment, cess, and reassessment earlier a decision can be fabricated regarding whether patients volition require further treatment	ascertainment care
This occurs when a md in the community refers a patient to the hospital for observation, bypassing the dispensary or emergency department	directly admission
Usually covers the deductible and copay or coinsurance of a primary health insurance policy	supplemental plan
The legal concern name of the exercise	billing entity
Supplemental plans designed past the federal regime but sold past private commercial insurancies companies to "encompass the gaps in Medicare"	medigap
An employee sponsored health benefits plan established by an act of congress in 1959	federal employee health benefits program (FEHBP)
This enables such members obtaining healthcare services while traveling or living in some other BCBS plan'due south service area to reveive benefits oftheir dwelling house plan contract and to admission local provider networks	bluecard programme
Special clauses stipulating additional coverage over and above the standard contract	riders
Offers choice and flexibility to subscribers who desire to receive a full range of benefits forth with the freedom to apply whatever licensed health care provider	idemnity coverage
The amount ordinarily charged for a detail medical service by providers within a particular geographic region for establishing their allowable rates	usual, customary,and reasonable (UCR)
HIPAA privacy standards crave providers to notify patients about their correct to	privacy
Evolution of an insurance claim begins when the:	patient contacts the provider'southward office and schedules an appointment
When a fee submitted to an insurance company is college than the health care provider's normal fee for the coded procedure,the provider must:	attach a letter to the claim explaining the rationale for the higher accuse
Optical character reader (OCR) guidelines were established when the :	CMS 1500 claim form was developed
When typewritten data is CMS-1500 claim form runs over into adjacent blocks, the claim will be:	rejected and returned to the provider
Which is the proper way to set up a rejected claim for resubmission?	create the corrected claim on an original (red-print) claim form
Remittance communication forms that are organized and filed according to month and payer are:	open assigned cases
Another term that tin be used to indicate a fee-for-service programme is a ____________ plan	noncapitated
Benefits such every bit coverage for copayments, deductibles, and coinsurance are offered by which blazon of insurance plan?	supplemental
Proir to the joint venture between Blueish Cross and Blue Shield, the Blue Shield plans covered simply:	physician services
Blue Cross facilities that had signed contracts to provide services to subscribers for special rates were known as_______hospitals	member
Which is the function of the BlueCross BlueShield Association(BCBSA)	national advertizing
The preferred provider network (PPN) immune rate is generally:	x per centum lower than the participating provider rate
Pocket-sized businesses are likely to select which BCBS coverage?	fee-for-service
What is an example of a benefit covered by BCBS bones coverage?	banana surgeon fees
What BCBS plan type offers the almost flexibility for subscribers?	indemnity coverage
The outpatient pretreatment authorization programme (OPAP) is also known as:	precertification
What title is listed on the BCBS identification cards for federal employees?	regime-wide service do good plan
BCBS Medicare supplemental plans are besides known equally?	medigap
Which is a program that requires providers to adhere to managed intendance provisions	preferred provider network
One of the expectations that nonparticipating provider has is to_____for services rendered:	obtain payment for the full fee charged
Which is considered a minimum benefit under BCBS bones coverage?	hospitalizations
Which is considered a service reimbursed by BCBS major medical coverage?	mental health visits
Which is a special clause in an insurance contract that stipulates additional coverage over and over and above the standard contract?	rider
Prospective authorization or precertification is a requirement of the_____BCBS managed care plan	outpatient pretreatment authorization