The broad range of activities that a managed care organization and its employees undertake to support the delivery of the promised benefits to members and to keep them satisfied with the company.

A combination of at least two managed care organizational models that are melded into a single health plan. Since its features do not uniformly fit one model, it is called a hybrid.

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A patient’s ability to obtain medical care determined by the availability of medical services, their acceptability to the patient, the location of health care facilities, transportation, hours of operation, and cost of care.

The balance of money owed to a client by others. 

The process by which an organization recognizes a program of study or an institution as meeting predetermined standards. Three organizations that accredit managed care plans are the National Committee for Quality Assurance (NCQA), URAC and the Joint Commission.

A person trained in statistics, accounting and mathematics who conducts statistical studies such as determining insurance policy rates, dividend reserves and dividends, as well as conducts various other statistical studies.

Medical treatment rendered to people whose illnesses or medical problems are short-term or don't require long-term continuing care. Unlike chronic care, acute care is often necessary for only a short time.

The ability of a patient to take their medication or follow a treatment protocol according to the directions for which it was prescribed; a patient taking the prescribed dose of medication at the prescribed frequency for the prescribed length of time. Also referred to as compliance.

A credit or debit amount appearing at the carrier/group level on claims and administrative fee invoices sent to plan sponsors or at a claim level on adjustment advice sent to pharmacies. An adjustment can result from claims processing and/or billing errors (e.g., incorrect dispensing fee paid, incorrect pharmacy paid, incorrect administration fee b [..]