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Insurance Principles 4

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
Created by: tina.reynolds