Question

1. Trending or peer comparison is known as:

2. A formal contract between the healthcare insurance company and individuals/groups for whom the company is assuming risk is a:

3. What is a request for reconsideration of a denial of coverage for healthcare services?

4. Determination of reimbursement payment based on the members insurance benefits is:

5. What is a report sent by a third party payer that lists payments, rejections, denials, and discounts?

Answer 1

2. Health insurance policy is a formal contract between the healthcare insurance company and individuals /groups for whom the company is assuming risk .

3. The request for reconsideration of a denial of coverage for healthcare services is called appeal .

4. Determination of reimbursement payment based on the members insurance benefits is called adjudication .

5. Allowable charge is a report sent by a third party payer that lists the payments , rejections , denials and discounts .