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FLAVIN MOS150U4

TERMINOLOGY

TermDefinition
If patients are covered by two insurance plans, the health insurance professional may have to submit a primary claim and a _____ claim. secondary
The prescription plan under CHAMPVA is considered “_____________,” and beneficiaries typically do not have to sign up for a Medicare Part D plan. credible coverage
If treatment is unavailable at an MTF and it becomes necessary for an individual to seek treatment in a civilian hospital, he or she sometimes must obtain a nonavailability statement
The acronym for the computerized data bank that lists all active and retired military service members is DEERS
Most state laws exclude coverage for injuries sustained while an employee is commuting to and from work. This is referred to as the _____ rule. coming-and-going
The worldwide healthcare system for the military is currently called TRICARE
TRICARE’s preferred provider option (PPO) is TRICARE Extra
The facility that handles TRICARE claims is called a claims processor
Which act provides workers’ compensation to employees of private maritime employers? Longshore and Harbor Workers’ Compensation Act
An individual responsible for investigating and resolving workers’ complaints against the employer is called a/an ombudsman
If there are no problems with the claim, the contractor should send a written notice, known as an __________, in about 1 month. EOB
An alternative to the suspension file is to record claims information on a columnar form called a/an insurance claims register
A maximum benefit amount paid for short-term disability policies is called a _____ cap. benefit
An explanation of benefits is often referred to as a/an remittance advice
Workers’ compensation insurance is considered to be “no-fault insurance,” which means benefits are paid regardless of who is to blame for the injury
An employee who is not entitled to paid holiday or sick leave and has no expectation of ongoing employment Casual employee
The service member, whether in active duty, retired or deceased Sponsor
Annual upper limit a family will have to pay for TRICARE Standard-covered services in any fiscal year Catastrophic cap
The goal is to return the injured worker to some sort of suitable, gainful employment that he or she can reasonable achieve Vocational rehabilitation
Provides workers’ compensation for nonmilitary federal employees Federal Employment Compensation Act
Serves as evidence of prior healthcare coverage under TRICARE Certificate of credible coverage
A series of files set up chronologically and labeled according to the number of days since the claim was submitted Suspension files
A treatment that focuses on helping individuals achieve independence in all areas of their lives. Occupational therapy
Income from employment Earned income
Organization that has agreed to provide services under the Ticket to Work program guidelines. Employment network
Created by: Iteach4Docs
 

 



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