Benefits

is a tailored network of providers aimed at providing enhanced quality and improved cost savings.

What is a co-pay?

• The maximum in benefit dollars paid by the insurer for certain services or conditions during the calendar or benefit year (may be a dollar amount, a number of visits amount, or unlimited)

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

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

What is a deductible

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

• The maximum in benefit dollars paid by the insurer for certain services or conditions during the calendar or benefit year (may be a dollar amount, a number of visits amount, or unlimited).

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

To create a Provider Phone Call Interaction, under the Provider menu on the ASPEN blue bar, which of the following do you select?

• Call

• Chat

• Research

When a provider bills the member the difference between what he billed and the allowed amount determined by the insurer.

What is PHI?

• Provider health information or PHI refers to individually identifiable provider information transmitted or maintained in any form or medium by a HIPAA covered entity.

• Protected health insurance or PHI refers to individually identifiable provider information transmitted or maintained in a specific form or medium by a HIPAA-covered entity.

• Protected health information or PHI refers to individually identifiable health information transmitted or maintained in any form or medium by a HIPAA covered entity (e.g. Health Insurance Company or health care provider).

Test that confirms the presence of an illness or injury by using instruments, apparatus, or chemical examination.

The use of radiant energy in the diagnosis of an illness or injury

is defined as services provided to a patient on a part-time, intermittent visiting basis by a licensed HHA.

HHA