Biomaterial Database

Using EDI for utilization management. 1994

J J Moynihan

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
D010351	Patient Discharge	The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.	Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D012015	Reference Standards	A basis of value established for the measure of quantity, weight, extent or quality, e.g. weight standards, standard solutions, methods, techniques, and procedures used in diagnosis and therapy.	Standard Preparations,Standards, Reference,Preparations, Standard,Standardization,Standards,Preparation, Standard,Reference Standard,Standard Preparation,Standard, Reference
D003195	Computer Communication Networks	A system containing any combination of computers, computer terminals, printers, audio or visual display devices, or telephones interconnected by telecommunications equipment or cables: used to transmit or receive information. (Random House Unabridged Dictionary, 2d ed)	Cognitive Radio,Computer Network Management,Databases, Distributed,Distributed Systems,Extranets,Intranets,Network Communication Protocols,Telecommunication Networks,Cognitive Radios,Communication Network, Computer,Communication Networks, Computer,Communication Protocol, Network,Communication Protocols, Network,Computer Communication Network,Database, Distributed,Distributed Database,Distributed Databases,Distributed System,Extranet,Intranet,Management, Computer Network,Network Communication Protocol,Network Management, Computer,Network, Computer Communication,Network, Telecommunication,Protocol, Network Communication,Radio, Cognitive,System, Distributed,Telecommunication Network
D006760	Hospitalization	The confinement of a patient in a hospital.	Hospitalizations
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D014600	Utilization Review	An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.	Review, Utilization,Reviews, Utilization,Utilization Reviews