bcbs and commercial exam study guide with complete solutions
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Course
Bluecross Blueshield
Institution
Bluecross Blueshield
bcbs and commercial exam study guide
with complete solutions
commercial health insurance - Answer️️ -covers the medical expenses for individuals
(e.g. private health insurance) and groups (e.g. employer group health insurance
commercial claim - Answer️️ -the patient is covered by a larg...
bcbs and commercial exam study guide
with complete solutions
commercial health insurance - Answer✔️✔️-covers the medical expenses for individuals
(e.g. private health insurance) and groups (e.g. employer group health insurance
commercial claim - Answer✔️✔️-the patient is covered by a large employer group health
plan (EGHP) and a patient is also a Medicare beneficiary. EGHP is primary
commercial secondary coverage - Answer✔️✔️-if the payers for the primary and
secondary or supplemental policies are different submit a CMS-1500 claim to the
primary payer
participating providers - Answer✔️✔️-the "blues" were pioneers in negotiating contracts
with providers of care. A participating provider is a health care provider who enters into
a contract with a BCBS corporation and agrees to
preferred provider network - Answer✔️✔️-a program that requires providers to adhere to
managed care provisions
PPN provider - Answer✔️✔️-a provider who is signed a PPN contract) agrees to accept
the PPN allowed rate , which generally ten percent lower than the PAR allowed rate.
The provider further agrees to abide by all cost containment, utilization and quality
assurance provisions of the PPN program.
nonparticipating providers - Answer✔️✔️-have not signed participating provider contract,
and they will expect to be paid the full fee charged for services rendered
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