Glossary Entries
Collection: Managed Care
- Actuary
- Admissions Per 1,000
- Adverse Selection
- AHP Accountable Health Plan
- Alternate Delivery Systems
- Application Integrators
- ASO Administrative Services Only
- ATM Asynchronous Transfer Mode
- Audit of Provider Treatment or Charges
- Capitation
- Carve-Outs
- Case Rate
- Character-based Terminal
- CHIN Community Health Information Network
- Clinic Without Walls (CWW)
- Clinical Data Repository
- Clinical Decision Support
- Clinical or Critical Pathways
- Closed Panel
- Collections Per 1,000
- Community Rating
- Computer-based Patient Record (CPR)
- Concurrent Review
- Continued Stay Review
- Cost Shifting
- Database Management System ( DBMS)
- Days (Or Visits) Per 1,000
- Direct Contracting
- Discounted Fee-For-Service
- Disease Management
- DRGs Diagnosis-Related Groups
- Drug Utilization Review (DUR)
- Electronic Data Interchange (EDI)
- Electronic Fund Transfers (EFT)
- Enrolled Group
- Enrollee
- ERISA -- Employee Retirement Income Security Act of 1974
- Exclusive Provider Organization (EPO)
- Experience
- Experience Rating
- Fee Schedule
- Fee-for-Service
- Flat Fee-Per-Case
- Formatting and Protocol Standards
- Gatekeeper
- Gross Charges Per 1,000
- Gross Costs Per 1,000
- Group Model
- GUI Graphical User Interface
- HCFA 1500
- Health Level Seven (HL7)
- HIPC Health Insurance Purchasing Cooperative
- HMO Health Maintenance Organization
- HPPC Health Plan Purchasing Cooperatives
- IBNR Incurred but not Reimbursed
- IDS/I(H)DS Integrated (Health) Delivery System
- Indemnity Health Insurance
- Interface
- IPA Independent Physician Association; Individual Practice Association; Independent Provider Association
- ISDN Integrated Services Digital Network
- LATA Local Access Transport Area
- Legacy Systems
- Local Exchange Carrier LEC
- Managed Behavioral Health Program (MBHP)
- Managed Health Care
- Master Patient/Member Index
- Medically Necessary
- MLR Medical Loss Ratio
- MSO
- Multiple Employer Trust (MET)
- Network Model
- Object Oriented Database
- Out-of-Area Benefits (HMO)
- PCP Capitation
- PCP Primary Care Provider
- PHO Physician-Hospital Organization
- PMPM Per Member Per Month
- PMPY Per Member Per Year
- Point-of-Care Technology
- POS Point-of-Service
- PPO Preferred Provider Organization
- Pre-Certification
- Predetermination
- Prepaid Group Practice Plan
- Profile
- Profile Analysis
- Provider Organization
- PTMPY Per Thousand Members Per Year
- Relational Data Model
- Resource-Based Relative Value Scale (RBRVS)
- Retrospective Review Process
- Risk Sharing
- Self-Funded Health Plans
- Self-insurance
- Sub-Capitation
- Telnet
- TPA Third-Party Administrator
- Treatment Episode
- UB-92 Uniform Bill 1992
- Utilization
- Value Added Networks (VANs)
- Withhold Pool