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5 Cards in this Set
- Front
- Back
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Adjudicate
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Automatic processing of claims by the system with no human interaction
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ASO
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For a fee, BCC administers claims,benefits and other administrative functions, for a self-insured group.This type of arrangement usually requires the employer to be at risk for the cost of health care services provided.
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CAPITATION
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A monthly prepayment fee to compensate the PMG or IPA for covered medical services.It is determinted by the age and gender of the member and based on the benefit agreement issued to the subscriber.
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SPI
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Special instruction.It documents unique conditions which are not included in other types of LL records.
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COB
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Coordination of BEnefits. Member has 2 insurances.
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