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Credentialing Eve

Consolidated Omnibus Budget Reconciliation Act of 1985
A plan that allows patients more choice in which healthcare provider they use
When a primary care doctor transfers care of a patient to a specialist
A company that administers, or handles, the drug benefit program for your employer or heath plan
The Current Procedural Terminology system. These codes identify services rendered to a patient by a physician
The specific form for providers to use when requesting a Benefit Investigation from AccessOne
A process by which the patient and a case manager work with the patient's doctor to design a plan to help the patient to achieve treatment goals in the most cost-effective manner
A contractual provision in an insurance policy that denies coverage for certain medical products or services
Amount that a health plan will pay for a certain service
A provision in the health insurance contract that applies when a person is covered under more than one insurance plan
An infusion of fluids containing medication into a vein in the hand or arm
Not all plans have a specific name
Request made to an insurance company by a patient or provider to reconsider a decision
The date that coverage began for an insured person enrolled in a health plan
Stands for Healthcare Common Procedure Coding System
The determination of the nature of a case of a disease or the distinguishing of one disease from another
Located in PatientPlus on the Benefit Profile tab under "Other Details"
A medical provider or healthcare facility that is not part of a health plan's list of preferred healthcare providers
A list of maximum payments for a specified service based on the relative value of the procedure
Total dollar amount that a health plan will pay for covered healthcare services during a specified period