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Billing and coding

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.

Blue Preferred Plan   Patient receives service at a discounted rate from a panel, or select group of physicians and other health care providers who participate in the program  
CAREN   computerized telephone inquiry system that provides information about a patient's eligibility, and benefits.  
C.O.B   program for determining which health insurer pays for services first when a subscriber is covered by more than one health care plan.  
Contract Number   The alpha numeric combination assigned to the person named on the ID card. 3 character must be included on the for,  
Copayment   This can be a set dollar amount based on contract benefits, or a percentage of the approved amount that the subscriber pays for medical services.  
Customary Charge   The charge which the physician or other provider usually charges for specific services  
Deductible   The amount that must be paid by a subscriber before an insurer begins to pay for medical services.  
DENIS   Dial in Eligibility Network and Information System- computer based system that gives you access to BCBSM through the internet to obtain information on patient's eligibility, benefits and claim's status.  
Dependent   person covered by the subscribers health care plan  
CMS 1500   Claim form used to report services rendered for payment  
HMO   Health Maintenance Organization- Patients must choose a PCP who provides services, must obtain referrals to see specialist  
Master Medical   The coverage that extends and adds benefits to a patient's basic BCBS contract  
Modifiers   A two character code- either 2 numbers or an alphanumeric code to further clarify information about a CPT code to the insurance carrier  
NASCO   National Accounts Service Company- reprsents employers such as GM, Ford, and Chrysler to name a few  
Non-Participating Physician   Physician who has not entered into a written contract to accept BCBS payments as payment in full. Patient would be responsible for the difference in the payment and the physician's charged amount  
Participating Physician   Physician who has entered into a written contract with BCBS to accept the payment from BCBS as payment in full. Patient can only be charged deductibles, co pay, on non-contract benefit  
Point of Service (Blue Choice)   Similar to HMO except that subscribers may recieve partial coverage for services not authorized by the PCP  
PPO (Blue Preferred Plan)   Preferred Provider Organization- patients recieve services at a discounted rate from a select group of physicians and other health care providers who participate in the program. May be co pays`  
Preauthorization   Process of obtaining approval for a service through the individual's insurance company by establishing that it is medically necessary  
Pre-existing condition   Medical condition that existed befor a member's BCBS coverage became effective  
Premium   A dollar amount that is paid for insurance coverage eithe by the insured or by the employer  
PIN   Unique 10 digit number assigned by BCBS to providers to identify them  
Subscriber   Person who is enrolled in BCBS for health care coverage. This is the person whose name is listed on the card  
NPI (National Provider ID)   A unique 10 digit number assigned to providers to ID them on a CMS 1500 claim form.  


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Created by: bossy777