A formal request to an insurance company for coverage or compensation for a covered loss or policy event.

Expression of dissatisfaction

demographic information, medical histories, test and laboratory results, mental health conditions, insurance information, and other data that a healthcare professional collects to identify an individual and determine appropriate care.

Ask: Who, What, When, Where, Why
Tell: Ded (If applies), Copay (If applies), COINS, OOP Max (If applies), Limits (If applies), Pre-auth (If applies)

NPAR vs. PAR

What the provider did

Quality of Service falls under this Category

Protected health information should not be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function.

Stop Loss Limitation

PCP

The form filed by a Facility

Dad: 06/05/1982
Mom: 02/25/1980
Mom is Primary

The website that houses Authorizations, QMSCO, Confidential Communications/SSCC

Family Amount can be satisfied by a family member or a combination of family members.

COB

Attaches to a procedure code

Medical necessity or not

First Name, Last Name, DOB, MID

A specified amount of money that a Member must pay before Anthem will help pay a claim.

SOB

Anthem send this to the Doctor after a claim is filed

Policy is not in CA

The document that has to do with divorced parents and their children

High deductible health plan and a spending account

QHE