Matching
Match the following:
Premises:
A compensation arrangement in which a provider is paid a per-member-per-month fee
A provider who is not under contract with a managed care plan
A licensed healthcare professional who has entered into an agreement to provide covered services to covered individuals
An insurance company, third-party administrator, or self-insured health benefit plan that is contractually obligated to make payments on behalf of covered persons
The determination of which health plan will pay for covered services as primary or secondary payer
Healthcare services provided to covered persons under the terms of the benefit plan
An individual who is an insured, enrolled participant or enrolled dependent under a benefit plan
Contract issued by a payer under which a covered person may be entitled to covered services
The amount a covered person is required to pay at the time of service
Covered services provided by a physician that are consistent with the physician’s training, licensure, and scope of practice
Responses:
participating provider
capitation
copayment
benefit plan
payer
covered person
coordination of benefits
covered services
contracted services
nonparticipating provider
Correct Answer:
Premises:
Responses:
A compensation arrangement in which a provider is paid a per-member-per-month fee
A provider who is not under contract with a managed care plan
A licensed healthcare professional who has entered into an agreement to provide covered services to covered individuals
An insurance company, third-party administrator, or self-insured health benefit plan that is contractually obligated to make payments on behalf of covered persons
The determination of which health plan will pay for covered services as primary or secondary payer
Healthcare services provided to covered persons under the terms of the benefit plan
An individual who is an insured, enrolled participant or enrolled dependent under a benefit plan
Contract issued by a payer under which a covered person may be entitled to covered services
The amount a covered person is required to pay at the time of service
Covered services provided by a physician that are consistent with the physician’s training, licensure, and scope of practice
Premises:
A compensation arrangement in which a provider is paid a per-member-per-month fee
A provider who is not under contract with a managed care plan
A licensed healthcare professional who has entered into an agreement to provide covered services to covered individuals
An insurance company, third-party administrator, or self-insured health benefit plan that is contractually obligated to make payments on behalf of covered persons
The determination of which health plan will pay for covered services as primary or secondary payer
Healthcare services provided to covered persons under the terms of the benefit plan
An individual who is an insured, enrolled participant or enrolled dependent under a benefit plan
Contract issued by a payer under which a covered person may be entitled to covered services
The amount a covered person is required to pay at the time of service
Covered services provided by a physician that are consistent with the physician’s training, licensure, and scope of practice
Responses:
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