Question

Match the following elements of managed care contracts to their corresponding descriptions.

Answer 1

Elements of managed care contracts:

Participating provider- A licensed healthcare provider who has entered into an agreement to provide covered services to covered individuals.

Benefit plan- Contract issued by a payer under which a covered person may be entitled to covered services.

Covered services- Healthcare services provided to covered persons under the terms of the benefit plan.

Copayment- The amount that a covered person is required to pay at the time of the service.

Coordination of benefits- The determination of which health plan will pay for covered services as primary on secondary payer.