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BCBS #1
| Question | Answer |
|---|---|
| Where was the first known plan of BCBS? | Palo Alto, California 1939. |
| When did Blue Cross Blue Sheild merge under single president? | 1977 |
| What is a Non-Profit? | They pay no taxes. they are charitable, they returned to program instead of shareholders and office coorporations. |
| What is a For-Profit? | They pay taxes on profits generated by the coorporation. |
| BCBS Contracts do what? | -Make prompt direct payments -Maintain regional professional rep to participate providers w/ claims |
| Connot cancel/forbidden | - Poor Health - Exceeding the average |
| What are BCBS Plans? | -Fee-For-Service -Managed care plans -Federal Employee Programs -Medicare Supplement Plans -Health care anywhere |
| Fee-for-Service (Traditional Coverage) | Basic and Major Medical |
| Basic coverage covers? | Hospitalizations, x-rays, surgical, obgyn, chemo, newborn, and intensive care. |
| Major Medical covers? | office visits, mental health visits, allergy testing injections, outpatient, durable medical equip., persciption drugs |
| Riders | treat you additional coverage over and above standard contract accidental injury |
| Special accidental injury rider | emergency care with in 24-72 hours of accidental injury |
| Indemnity coverage | offers choice and flexibility |
| Home health care and Hospice | alternatives to traditional hospital |
| outpatient pretreatment authorization plan (OPAP) | requires preauthorization of outpatient- aka prospective aurthorization or percertification |
| Member | is the policyholder |
| Mandatory Second Surgical Opinion (SSO) | for elective nonemergency surgical care |
| Federal Health Benefits Program (Federal Employee Program) | use a three digit enrollment code for ID, Front |
| Medicare Supplemental Plans | Medigap |
| Healthcare Anywhere | coverage throughout US |
| Away From Home Care Program | allows those residing outside their home at least 90 days enroll with loval HMO |
| Claims Processing | BCBS palns process their own claims, deadline filling 1year CMS 1500 form is used |
| Free schedules | charts documented charges each procedure use a plan called usual, customary, and reasonable. |
| Assignment of benefits | Payment made dirctly to the provider |
| Purchase noncancelation plan | clause can not be dropped |
| ICD- 9 Codes | Doctor can have up to 4 codes and they are listed in order of severity |
| CPT | Current procedural terminology descending order of complexity |
Created by:
hannahpippel
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