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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!
Select a category to expand:
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
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
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
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
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.
- What is a Health Savings Account (HSA) and Health Reimbursement Account (HRA)?
- What are the benefits of HSAs and HRAs?
- How should providers handle patients with HSAs and HRAs?
Self-paced Module | 10 minutes | All Providers
Insurance is based on the concept of risk. Learn how it relates back to CareFirst plans.
- Overview of risk
- Overview of health insurance
- How risk and health insurance intertwine
- Explanation of risk-based health insurance
- Explanation of non-risk based health insurance
- Locating risk vs. non-risk policy information in CareFirst Direct
Self-paced Module | 15 minutes | All Medical Providers
Guidelines on telehealth usage and claims procedures.
- The definitions of telehealth and telemedicine
- Types of telehealth services
- Types of telehealth visits
- Telehealth claims submissions
What Is A Third Party Administrator (TPA)?
Self-paced Module |10 minutes | All Medical Providers
This course will introduce providers to Third Party Administrators (TPAs).
Webpage | 5 minutes | All Medical Providers
Not sure what a term means? Look at our Health Insurance Glossary.
- Search the interactive alphabet for a term
- Review term definitions
Webpage | 5 minutes | All Dental Providers
Not sure what a term means? Look at our Dental Insurance Glossary.
- Search the interactive alphabet for a term
- Review term definitions
Webpage | 5 minutes | All Providers
A-Z reference of acronyms and abbreviations you may encounter with working with CareFirst.
- Search the interactive alphabet for an abbreviation or acronym
- Review meaning of abbreviation or acronym