Health Ins and Claims Chapter 3
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| voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law | show 🗑
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| show | capitation
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| submits written confirmation, authorizing treatment, to the provider | show 🗑
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| show | concurrent review
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| health care plan that encourages individuals to locate the best health care at the lowest possible price, with the goal of holding down costs by asking employees to be more responsible for health care decisions and cost-sharing. | show 🗑
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| show | enrollees
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| managed care plan that provides benefits to subscribers if they receive services from network providers | show 🗑
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| show | fee-for-service
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| show | gatekeeper
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| tax-exempt account offered by employers with any number of employees, which individuals use to pay health care bills.It is usually in connection with a high deductible insurance plan. | show 🗑
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| contracted health care services provided to subscribers by two or more physician multi-speciality group practices | show 🗑
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| physician or health care facility under contract to the managed care plan | show 🗑
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| show | physician incentives
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| delivers health care services using both an HMO network and traditional indemnity coverage so patients can seek care outside the HMO network. | show 🗑
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| show | (PPO)preferred provider organization
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| responsible for supervising and coordinating health care services for enrollees and preauthorizing referrals to specialists and inpatient hospital admissions (except in emergencies) | show 🗑
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| show | prospective review
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| show | retrospective review
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| show | second surgical opinion
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| person in whose name the insurance policy is issued | show 🗑
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| show | utilization management (utilization review)
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| combines health care delivery with the financing of services provided | show 🗑
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| owned by hospital(s) and physician groups that obtain managed care plan contracts; physicians maintain their own practices and provide health care services to plan members | show 🗑
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