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Ins._4
Insurance Principles 4
Term | Definition |
---|---|
Practice Management System | Software that deals with the administration and financial operations of a medical practice, including patient registration, scheduling, claims submission, and billing. |
Pre-existing Condition | A health problem that exists before enrolling in or becoming eligible for a health plan |
Preferred Provider Organization (PPO) | Health care providers, including physicians, hospitals, clinics, and pharmacies, which contract with private payers to provide care to the plan's members |
Premium | Payment made by a member or subscriber for coverage under a policy; usually on a monthly or yearly basis |
Referral | Pre-approval of health care for an HMO member by a primary care provider |
Reinstatement | Restoration of a lapsed policy |
Remittance Advice (RA) | Itemized statement provided to providers after a claim has been processed |
Self-insured | The insurer, often an employer, assumes the risk of paying directly for medical services |
State Children's Health Insurance Program (SCHIP) | Provides health insurance benefits for children who are in families whose income is not low enough to qualify for Medicaid; coverage is effective until they are 19 |
Third-party Administrator (TPA) | An organization that collects premiums, manages member lists, and processes and pays claims for another organization or employer |
TRICARE | Federal health insurance plan through the Department of Defense for military personnel and their families |
Worker's Compensation Plans | Federal-or state- designated coverage for work-related illnesses and injuries |