Question

Group B Word Pool

11. An approved list of physicians, hospitals, and other providers _______________________

12. A decision-making process used by managed care organizations; used to manage healthcare costs through case-by-case assessments of the appropriateness of care _______________________

13. The primary care provider in charge of a patient’s treatment; additional treatment, such as referrals to a specialist, must be approved by this person _______________________

14. A service provided by various insurance companies for providers to look up patient insurance benefits, eligibilit , claims status, and explanation of benefits ______________________

15. A designated person who receives funds from an insurance policy _______________________

16. A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services _______________________

17. The amount of time a patient waits for disability insurance to pay after the date of injury _______________________

18. A payment arrangement for healthcare providers; the provider is paid a set amount for each enrolled person assigned to them, per period of time, whether or not that person has received services _______________________

preauthorization
gatekeeper
provider network
capitation
utilization management
online provider insurance web
portal
waiting period
beneficiary

Answer 1

11. An approved list of physicians, hospitals,and other providers--------------------------------Provider Network

12. A decision making process used by managed care organizations;used to mange healthcare cost through case-by-case assessments of the apptopriateness of care------------Utilization Management

13. The primary care provider in charge of a patient's treatment;additional treatment,such as referrals to a specialist,must be approved by the person-------------------------Gatekeeper

14. A service provided by various insurance companies for providers to look up patient insurance benefits,eligibilit,claim status,and explanation benefits-----------------Online provider insurance web

15. A designated person who recieves funds from an insurance policy----------------------Beneficiary

16. A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services-------------------------Preauthorization

17. The amount of time a patient waits for disability insurance to pay after the date of injury----------------------------Waiting period

18. A payment arrangement of healthcare providers;the provider is paid a set amount for each enrolled person assigned to them, per period of time,whether or not that person has recieved services------------------Capitation