Question

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

10
A. covered person
F. copayment
B. payer
G. benefit plan
C. participating provider
H. covered services
D. contracted services
I. nonparticipating provider
E. coordination of benefits
J. capitation
A licensed healthcare professional who has entered into an agreement to provide covered
services to covered individuals
Contract issued by a payer under which a covered person may be entitled to covered
services
Healthcare services provided to covered persons under the terms of the benefit plan
The amount a covered person is required to pay at the time of service,
The determination of which health plan will pay for covered services as primary on
secondary payer​

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.