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Call Center Terminology

Across
Calls for this group should go to 888-422-8181
Area that handles large amount of claim dollars
-------- injections always require PA
The Employee Retirement Income Security Act of 1974 is also known as ------
Non-medical evaluations for employment, marriage license, judicial or administrative proceedings, school, travel or purchase of insurance, etc are called ---------
------- is a 24/7/365 Medical Care
------------Services-Supplemental healthcare services such as laboratory work, x-rays or physical therapy that are provided in conjunction with medical or hospital care
a document giving official notice whether the requested services will be honored under the health plan and any special circumstances that apply
----------- plans are health plans that were in place before March 23, 2010
Down
-A person admitted to a hospital for at least 24 hours is considered ---------
What is the rule for Radiologist, anesthesiologist, independent labs, pathologist, and emergency room physician paying network level when referred by network provider or in network hospital
When checking the Summary of Benefits and/or Plan Document for a benefit and the plan is ------ , recommend a PA
The purpose of the ------------- is to determine if a proposed Hospital stay is appropriate and if the treatment is appropriate for the indicated diagnosis
Where you may find notes regarding COB and HWW
-the subscriber, employee or policy holder of an insurance plan
------------(Consolidated Omnibus Budget Reconciliation Act of 1985
identifies doctors and hospitals that – when working together – meet national quality measures and adopt processes that are better for patients
--------is an easy to use, noninvasive colon cancer screening test based on the latest advances in stool DNA science
--------- is made up of a certain group of Providers that offer the highest quality and lowest cost for certain services
Per CDC Guidelines, members must be over the age of 60 to receive the Shingles (Zostavax) vaccine.