HIPAA AND ELIG

PPO

A calendar year means the policy’s benefit period runs from January 1 through December 31 of the same year.

• Calendar Year

• Benefit Year

• Benefit Period

NPI

West ROM consist of what state?

• CA,CO,NV

• CA,CO,NB

• CO,RA,NO

If the call came in HIPAA Validated the Provider verifies the following.

• NPI/TAX ID, Member Name, DOB

• TAX ID/NPI, Members ID, DOB

• TAX ID/NPI, Members ID, Members name

EPO

The amount of covered expenses for medical treatment that must be incurred and paid by the insured before benefits become payable by the insurer

Also referred to as a contracting provider or an in-network provider.

Also referred to as an out-of-network provider.

A provision by which the member is responsible for paying a minimal dollar amount at the time a service is rendered.

• Co-Insurance

• Deductible

• Copay