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Terms in this set (138)
provider - general A party rendering medical care such as a physician
or hopsital
facilities provider Includes hospitals, skilled nursing facilities, assisted
living facilities, home health agencies, and
ambulatory centers
professional provider includes physicians, pharmacists, nurses, therapists,
and allied health professionals
primary care primary care physicians are usually trained in family
practice, general practice, general internal
medicine, and pediatrics. Physicians serving in
primary care roles usually treat common medical
conditions or injuries, and often provide preventive
health screenings. They are often viewed as serving
as a coordinator of a patient's care, assessing a
patient's condition, and treating if a simple
condition, or referring a patient to a specialist
physician.
, specialist specialists normally do not provide primary care
services, instead focusing their work based on in-
depth training in different diseases, body systems
or types of health care service
third party payer a health insurance plan paying for the services
out-of-pocket-payment payments by patients that can be required as a part
of a health insurance plan are: deductible,
copayment, and coinsurance
deductible the deductible is a pre-determined amount that the
patient pays before the insurer begins to pay for
service
coinsurance corinsurance is a percentage of the insurance
payment amount that is paid by the patient, along
with the amount paid by the insurerer
indemnify payment on behalf of the patient - costs covered
under the insurance contract between the patient
and the insurer
claim a bill for services provided
pre-authroization permission by the insurer to render services to the
patient before actually treating the patient. This
includes verification of payment for the service by
the insurer
benefit payment once the insurer has determined the claim is
appropriate, a payment is made to the provider.
This payment is officially termed a benefit payment
Answers | Verified | Latest Update 2026
Save
Terms in this set (138)
provider - general A party rendering medical care such as a physician
or hopsital
facilities provider Includes hospitals, skilled nursing facilities, assisted
living facilities, home health agencies, and
ambulatory centers
professional provider includes physicians, pharmacists, nurses, therapists,
and allied health professionals
primary care primary care physicians are usually trained in family
practice, general practice, general internal
medicine, and pediatrics. Physicians serving in
primary care roles usually treat common medical
conditions or injuries, and often provide preventive
health screenings. They are often viewed as serving
as a coordinator of a patient's care, assessing a
patient's condition, and treating if a simple
condition, or referring a patient to a specialist
physician.
, specialist specialists normally do not provide primary care
services, instead focusing their work based on in-
depth training in different diseases, body systems
or types of health care service
third party payer a health insurance plan paying for the services
out-of-pocket-payment payments by patients that can be required as a part
of a health insurance plan are: deductible,
copayment, and coinsurance
deductible the deductible is a pre-determined amount that the
patient pays before the insurer begins to pay for
service
coinsurance corinsurance is a percentage of the insurance
payment amount that is paid by the patient, along
with the amount paid by the insurerer
indemnify payment on behalf of the patient - costs covered
under the insurance contract between the patient
and the insurer
claim a bill for services provided
pre-authroization permission by the insurer to render services to the
patient before actually treating the patient. This
includes verification of payment for the service by
the insurer
benefit payment once the insurer has determined the claim is
appropriate, a payment is made to the provider.
This payment is officially termed a benefit payment
