We've compiled a list of common health care and health insurance related terms to help you better understand words commonly used in our industry and on our web site.
Terms appear in alphabetical order. To use the glossary, please choose the first letter of the term you would like to view.
PARTICIPATING PROFESSIONAL PROVIDER
A professional provider with whom Capital BlueCross has a contract concerning payment for services covered by Capital BlueCross contracts.
A provider that has a contract with the Plan pertaining to payment for covered services rendered to a member. A participating provider may submit a claim for payment directly to the Plan.
PLACE OF SERVICE
The location where health services are rendered (i.e., office, home, hospital, etc.).
The amount of money the insured person (and/or the insured person's employer) pays the insurance company for enrollment in an insurance plan.
The preauthorization process involves clinical review of selected covered services prior to the service being rendered to assess the medical necessity of the service and appropriateness of level of care.
Description of the service provided.