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Insurance Basics

The ins and outs of how insurance works, insurance plan types and more!

Featured Course

New to the insurance field or just want a refresher? Take “Types of Plans” for a complete overview of different insurance plan types. Learn how each plan type handles referrals, benefits, out-of-pocket costs, and more!

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Types of Plans

Self-paced Module | 30 minutes | All Medical Providers

An overview of different insurance plan types.

All about Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) products
All about Point-of-Service (POS) and Indemnity (Traditional) products
All about Exclusion Provider Organizations (EPO) and Consumer Directed Health Plan (CDH)
Product plan type similarities and differences

Claims 101

Self-paced Module | 30 minutes | All Medical Providers

An overview of health insurance claims and what happens when a claim is submitted.

What is a claim and a review of the types of claim forms
An overview of claim submissions
Clean Claims Legislation
Claim statuses and errors
The lifecycle of claims for different product types
Common claims terms and definitions

Insurance 101

Self-paced Module | 10 minutes | All Medical Providers

An overview of health insurance claims and what happens when a claim is submitted.

The definition of health insurance
Common health insurance terms and definitions
Differences between copays, deductibles, out-of-pocket maximums, coinsurances, etc.

Medicare and Medicare Coordination

Self-paced Module | 10 minutes | All Medical Providers

An overview of Medicare, Medicare coordination, and the Medicare crossover process.

The definition of Medicare
Crossover claims
The Medicare Crossover process
Claims submission tips

Medicaid

Self-paced Module |15 minutes | All Medical Providers

A general overview of Medicaid, Medicaid programs, and CareFirst Medicaid Managed Care Organization (MCO) available at CareFirst Community Health Plan Maryland (CareFirst CHPMD).

An overview of Medicaid
Medicaid programs
CareFirst Community Health Plan Maryland (CareFirst CHPMD)
Other resources available for Medicaid

Coordination of Benefits (COB)

Self-paced Module | 10 minutes | All Medical Providers and Office Staff

An overview of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively "CareFirst") coordination of benefits process, how to determine primary or secondary coverage, Medicare, Medicaid, birthday rule, additional coordination of benefits rules, subrogation, crossover claims, and who to call for assistance.

The definition of Coordination of Benefits (COB)
Determining primary or secondary coverage
COB Rules
COB Claims Medicare
Subrogation
Medicare
Medicaid
Maintenance of Benefits (MOB)
The Medicare crossover process
Claims submission tips
Who to call for assistance

HSAs and HRAs

Self-paced Module | 15 minutes | All Medical Providers and Office Staff

An overview of HSAs and HRAs, how they interact with CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively "CareFirst") products, and the provider impact when a patient uses an HRA/HSA.