Exam 4: Processing an Insurance Claim

A clearinghouse that involves value-added vendors, such as banks, in the processing of claims is called a value-added __________ to improve efficiency and reduce expenses.

Which is the insurance plan responsible for paying health care insurance claims first?

Any procedure or service reported on the claim that is not included on the master benefit list is a noncovered benefit and will result in claims __________.

Secondary insurance is the insurance plan that is billed after the primary insurance plan has paid its contracted amount and the provider's office has received a(n) __________ from the primary payer.

A policyholder or __________ is the person in whose name the insurance policy is issued.

Which is the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the insurance company is obligated to pay any benefits?

A pre-existing condition is any medical condition that was diagnosed and/or treated within a specified period of time __________ the enrollee's effective date of coverage.