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Billing and Reimbursement > Defition > Flashcards

Defition Flashcards

1
Q

Six digit number that identify their insurance company

A

BIN

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2
Q

Promote industry solution that improves patient , safety, and health outcomes and reduce cost

A

NCPDP

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3
Q

ID number issued by the central of Medicare and Medi-Cal service for prescriber and pharmacist

A

NPI

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4
Q

Unique number that identifies a prescriber ,pharmacy ,manufacture that is register to prescribe, dispense and handle control substance

A

DEA#

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5
Q

A free directory of all active NPI record

A

NPPES registry

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6
Q

Identifies manufacturer, name, strength, dosage, form, and package size of each joke

A

I NDC

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7
Q

DAW code

A

Indicates why a particular product was dispense

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8
Q

Days’ supply

A

The number of days the medication will last

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9
Q

Prescription number

A

Unique pharmacy generate a number that identifies a specific prescription order

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10
Q

Quantity

A

Amount of medication to be dispense

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11
Q

Dual eligible

A

Patient is covered by multiple separate insurance claim

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12
Q

ID number

A

Identify the policyholder’s account

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13
Q

Name

A

The policy holder’sname

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14
Q

 Depend code

A

Which family member is using benefits

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15
Q

Group number

A

Identifies the benefit of specific plan

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16
Q

BIN

A

The correct insurance company to bill for reimbursement

17
Q

 PCN

A

A secondary identifier to route pharmacy claim to the insurance

18
Q

Effective date

A

Effected day insurance coverage begin

19
Q

A company that reimburse healthcare provider to their services

A

The party payer

20
Q

I set amount of money paid by the patient until the insurance pays for the health coverage

A

 Deductible

21
Q

An ongoing amount pay by an individual to maintain insurance coverage

A

Premium

22
Q

A set amount of money to be pay for each prescription

A

copay

23
Q

A list of drugs, covered by the insurance, organized and tier by cost

A

Formulary

24
Q

Annual parade to select benefit coverage for the following calendar year

A

 Open enrollment

25
Q

A percentage of the drug cost to be paid by each prescription

A

Coinsurance

26
Q

The amount of money the patient pays for the prescript

A

 Out-of-pocket costs

27
Q

Portable contract that includes important detail up plan

A

 Insurance card

28
Q

No party payer process of accepting or denying a submitted claim

A

 adjudication

29
Q

Electronic submission of a claim to an insurance company

A


Ad justification

30
Q

A free directory of the active NPI

A

NPPES national plan on prescriptions enumeration system registry

31
Q

Six digit number that identify the insurance company

A


BIN bank identification number

32
Q

Promote industrial solutions that improved patient safety, and health outcomes and reduce costs

A

 NCPDP  national council for prescription drug program

33
Q

ID number issued by the center of Medicare and Medicaid services to prescriber  and Pharmacist

A

NPI.  National provider identifier

34
Q

It is hired by the third-party payer to administer the prescription, drug plans and acts at a middle man between the insurer and the pharmacy

A

PBM (pharmacy benefit manager

35
Q

Insurances that keep cost low while providing quality, comprehension healthcare‘s, Medicaid, Medicare, and government respond, example HMO, PPO, Medicare, Medicaid.

A

MCO

36
Q

Center for Medi-Cal Medicare service is the Part health and human service (HHS). and it is same as Medicare is federal run government health insurance program which administered iby CMS

A

MCS

37
Q

The Joint commission refers to as a CAHO which Wes the joint commission on accreditation of healthcare organization TJC is one of the few national organization to be recognized by CMS for acquisition service

A

TJC

38
Q

It is a Medication error is any preventable event that may cause a lead to an in appropriate medication use of the patient home while medication is in the control of the healthcare for Professional patient and consumer

A

What is a medication era joint commission?

Billing and Reimbursement (10 decks)

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