Biomaterial Database

Reducing retiree medical costs through utilization management. 1993

G B Wagoner

William M. Mercer, Inc., Richmond, VA.

UI	MeSH Term	Description	Entries
D007345	Insurance Claim Review	Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.	Claims Review,Insurance Audit,Insurance Claims Processing,Analysis, Claims,Claim Review, Insurance,Claims Analysis,Insurance Claims Analysis,Review, Claims,Review, Insurance Claim,Analyses, Claims,Analyses, Insurance Claims,Analysis, Insurance Claims,Audit, Insurance,Audits, Insurance,Claim Reviews, Insurance,Claims Analyses,Claims Analyses, Insurance,Claims Analysis, Insurance,Claims Processing, Insurance,Claims Reviews,Insurance Audits,Insurance Claim Reviews,Insurance Claims Analyses,Processing, Insurance Claims,Reviews, Claims,Reviews, Insurance Claim
D008329	Managed Care Programs	Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.	Case Management, Insurance,Insurance Case Management,Managed Health Care Insurance Plans,Managed Care,Care, Managed,Managed Care Program,Management, Insurance Case,Program, Managed Care,Programs, Managed Care
D010934	Planning Techniques	Procedures, strategies, and theories of planning.	Planning Theories,Methodology, Planning,Planning Methodology,Planning Technic,Planning Methodologies,Planning Technics,Planning Technique,Planning Theory,Technic, Planning,Technique, Planning,Theory, Planning
D011306	Prescription Fees	The charge levied on the consumer for drugs or therapy prescribed under written order of a physician or other health professional.	Dispensing Fees,Fees, Prescription,Dispensing Fee,Fee, Dispensing,Fee, Prescription,Fees, Dispensing,Prescription Fee
D003363	Cost Control	The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)	Cost Containment,Containment, Cost,Containments, Cost,Control, Cost,Controls, Cost,Cost Containments,Cost Controls
D006264	Health Benefit Plans, Employee	Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.	CHAMPUS,Employee Health Benefit Plans
D006278	Medicare	Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)	Health Insurance for Aged and Disabled, Title 18,Insurance, Health, for Aged and Disabled,Health Insurance for Aged, Disabled, Title 18,Health Insurance for Aged, Title 18
D012179	Retirement	The state of being retired from one's position or occupation.	Retirements
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D017049	Employer Health Costs	That portion of total HEALTH CARE COSTS borne by an individual's or group's employing organization.	Health Costs, Employer,Employer Health Cost,Health Cost, Employer