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5 Written questions

5 Matching questions

  1. Formal referral
  2. Physician Provider Group (PPG)
  3. POS
  4. EPO
  5. Gatekeeper (Primary care physician)
  1. a Is a physician who controls patient access to specialists and diagnostic testing services.
  2. b Physician owned business that has the flexibility to deal with all forms of contract medicine and offers its own packages to business groups, unions and the general public.
  3. c An authorization request is required by the MCO contract to determine medical necessary, this can be done over the phone, or completed authorization form mailed, transmitted via fax or email.
  4. d - Exclusive Provider Organization.
  5. e - Point-of-service Option or Plan

5 Multiple choice questions

  1. To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.
  2. Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
  3. - Health Plan Employer Data Information Set
  4. - America's oldest privately owned prepaid medical group.
  5. Card given to each enrollee of a managed care plan include and list patient's the name and member number

5 True/False questions

  1. PreauthorizationA requirement of some health care plans to obtain permission for a service or procedure before it is done and to see whether the insurance program agrees it is medically necessary.


  2. ERISA- Employee Retirement Income Security Act


  3. URUtilization Review


  4. NCQA- Independent (or Individual) Practice Association.


  5. Tertiary careReferral of a patient recommended by one specialist to another specialist.


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