Medical Terminology
Copay :-
Co-pay is the amount that a patient is responsible for at the time they visit a physician or hospital, or have a prescription filled. The patient is responsible for this up-front fee, while the insurance provider covers the remaining cost of a medical service or prescription
Deductible :-
Deductible represents the amount of eligible medical expenses that must be paid by the insured before the insurance company begins to reimburse for covered expenses
Coinsurance :-
The portion of eligible expenses that plan members are responsible for paying after the deductible is met. It is a percentage of the total cost.
Out of Pocket (OOP) :-
The annual out of pocket maximum refers to the actual amount of money you will pay for your medical cost before an insurance plan pays 100% of your bill.
Primary care physician (PCP) :-
A primary care physician, or PCP, is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. This term is primarily used in the United States. In Britain and many other English-speaking countries, the equivalent term is “General Practitioner” or “Doctor”.
Referral :-
When your primary care physician (PCP) refers you to a specialist, you will receive a written referral authorization to meet the Specialist. In Managed care policy referral is must.
Timely Filing Limit of the claim (TFL)
Time frame to submit the claim (medical bills) to the insurance company. Claims will only be processed according to the timely filing guidelines as defined by the Insurance company. Each Insurance has there own filing limit.
Medical Terminology
Claim Mailing Address :-
Once the claim form is completed, send it by mail to the Insurance billing address. Need to check the claims address on the member's ID card as these are submitted to the medical carrier.
Online verification
1 Eff Date
2 Plan Type
3 Copay PCP / SPL
4 Deductible
5 Out of Pocket
6 Policy coverage (100%, 80%.....)
7 PCP Name
8 Referral
9 Lifetime Maximum (LT)
10 Timely Filing Limit of the claim (TFL)
11 Claim mailing address
On Call verification
Doctor's are named as..
Primary Care Physician (PCP)
Gate Keeper
Provider
Copay :-
Co-pay is the amount that a patient is responsible for at the time they visit a physician or hospital, or have a prescription filled. The patient is responsible for this up-front fee, while the insurance provider covers the remaining cost of a medical service or prescription
Deductible :-
Deductible represents the amount of eligible medical expenses that must be paid by the insured before the insurance company begins to reimburse for covered expenses
Coinsurance :-
The portion of eligible expenses that plan members are responsible for paying after the deductible is met. It is a percentage of the total cost.
Out of Pocket (OOP) :-
The annual out of pocket maximum refers to the actual amount of money you will pay for your medical cost before an insurance plan pays 100% of your bill.
Primary care physician (PCP) :-
A primary care physician, or PCP, is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. This term is primarily used in the United States. In Britain and many other English-speaking countries, the equivalent term is “General Practitioner” or “Doctor”.
Referral :-
When your primary care physician (PCP) refers you to a specialist, you will receive a written referral authorization to meet the Specialist. In Managed care policy referral is must.
Life Time Maximum (LTM) :-
The lifetime maximum insurance benefit is the maximum amount that your insurance company will pay during your lifetime.
The lifetime maximum insurance benefit is the maximum amount that your insurance company will pay during your lifetime.
Timely Filing Limit of the claim (TFL)
Time frame to submit the claim (medical bills) to the insurance company. Claims will only be processed according to the timely filing guidelines as defined by the Insurance company. Each Insurance has there own filing limit.
Medical Terminology
Claim Mailing Address :-
Once the claim form is completed, send it by mail to the Insurance billing address. Need to check the claims address on the member's ID card as these are submitted to the medical carrier.
Online verification
1 Eff Date
2 Plan Type
3 Copay PCP / SPL
4 Deductible
5 Out of Pocket
6 Policy coverage (100%, 80%.....)
7 PCP Name
8 Referral
9 Lifetime Maximum (LT)
10 Timely Filing Limit of the claim (TFL)
11 Claim mailing address
On Call verification
Doctor's are named as..
Primary Care Physician (PCP)
Gate Keeper
Provider
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