| 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 |
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| 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 |
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| D008511 |
Medicine |
The art and science of studying, performing research on, preventing, diagnosing, and treating disease, as well as the maintenance of health. |
Insurance Medicine,Medical Specialities,Medical Specialties,Medical Specialty,Specialities, Medical,Specialties, Medical,Specialty, Medical,Insurance Medicines,Medical Speciality,Medicine, Insurance,Medicines, Insurance,Speciality, Medical |
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| D012017 |
Referral and Consultation |
The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide. |
Consultation,Gatekeepers, Health Service,Hospital Referral,Second Opinion,Consultation and Referral,Health Service Gatekeepers,Hospital Referrals,Referral,Referral, Hospital,Referrals, Hospital,Consultations,Gatekeeper, Health Service,Health Service Gatekeeper,Opinion, Second,Opinions, Second,Referrals,Second Opinions |
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| D002204 |
Capitation Fee |
A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient. |
Fee, Capitation,Capitation Fees,Fees, Capitation |
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| D006801 |
Humans |
Members of the species Homo sapiens. |
Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man |
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| D013038 |
Specialization |
An occupation limited in scope to a subsection of a broader field. |
Specialism,Specialists,Specialist |
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| D014481 |
United States |
A country in NORTH AMERICA between CANADA and MEXICO. |
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| 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 |
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| D017410 |
Practice Guidelines as Topic |
Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. |
Clinical Guidelines as Topic,Best Practices,Best Practice |
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