This is insurance that employers are required to have to cover medical care of employees who get sick or are injured on the job.

This is a process of tracking, reviewing and rendering opinions about care. The practices of pre-certification, recertification, retrospective review and concurrent review all describe utilization rev [..]

Usual, customary and reasonable charges reflect the prevailing fees for service in an area. Many insurers and managed care plans reimburse providers based on UCR charges. This term may be synonymous w [..]

Third-party administrators handle the administrative duties and sometimes utilization review for self-funded plans.

This is any private health insurance plan held by a Medicare or commercial beneficiary, including Medigap policies or post-retirement benefits. Supplemental insurance usually pays the deductible or co [..]

A skilled nursing facility generally is an institution for convalescence or a nursing home. Skilled nursing facilities provide a high level of specialized care for long-term or acute illness.

A record of account status (blue and white form) sent to patients monthly to advise them of the previous period's transactions and activity on the account.

A patient who has no insurance or does not want the services rendered to be filed with his or her insurance company. This patient must make a pre-care deposit.

In self-insured (self-funded) plans, the employer (rather than an insurance company or managed care plan) assumes the risk of medical costs. Self-funded plans are exempt from state laws and regulation [..]

This is the insurance company responsible for processing the claim after the primary insurance determines what it will pay.