1.
Systematic reviews and evaluations of records and other data to determine quality of services or products provided.
2.
A person designated by an insurance policy to receive benefits or funds.
3.
A comprehensive health care program in which the Office of Veterans' Affairs (VA) shares the cost of covered health care services and supplies with eligible beneficiaries.
4.
An arrangement in which the insured must pay either a fixed amount or a percentage of the cost of medical services covered by the insurer.
5.
A legally enforceable agreement.
6.
A process in which two or more insurance companies apportion each one's share of responsibility of payment of a claim for health care services provided to an insured client.
7.
A cost-sharing requirement of most insurance policies, under which is the responsibility of the insured to make a payment of a specified amount at the time of treatment or purchase of a prescription.
8.
A rejection of a medication refill due to an amount that has exceeded the preapproved supply for a specific period of days.
9.
A specific amount of money that must be paid yearly before the policy benefits begin.
10.
The spouse and children of the insured who are also covered under the terms of the policy.
11.
An evaluation of a pharmacy or related facility that does not involve an auditor being sent out to the location.
12.
The determination of the exact coverage to which the insured is entitled.
13.
An intensive, systematic investigation of a pharmacy or other facility's operational practices, procedures, records, inventory, and accounting.
14.
A type of contract purchased by individuals or employers that provides reimbursement for specified medical and related expenses.
15.
A government-funded health cost assistance program that pays for health services and pharmacy expenses for enrolled U.S. citizens who cannot afford to pay for their own health care. It also covers those who are blind, disables, orphaned, or underage paren
16.
A government-funded program that pays for health coverage for people over age 65, and certain other persons.
17.
A type of health plan providing coverage within Part C of Medicare; it pays for managed health care based on a monthly fee rather than on the basis of billing a fee for each service provided.
18.
Payment by the insurer or by the patient of more than the amount due.
19.
An individual numeric code that identifies a specific patient, used in pharmacies and other health care facilities.
20.
A rejection of a medicaiton refill in which the amount requested exceeds the amount allowed b insurance plan.
21.
The exclusion of specific medical conditions or procedures from reimbursement under a health insurance policy.
22.
Prior authorization; many private insurance companies and prepaid health plans have certain requirements that must be met before they will approve diagnostic testing, hospital admissions, inpatient or outpatient surgical procedures, other speficif procedu
23.
The cost of the coverage provided by an insurance policy.
24.
A rejection of a medicaiton refill in which the refill has been requested too soon after a previous refill was requested.
25.
The individual or organization protected in case of loss under the terms of an insurance policy
26.
An organization or corporation that pays medical claims for patients; third-party payers reimburse providers directly, with patients making only any required copayments.
27.
The amount of time form the date of service to the date (deadline) a claim can be filed with the insurance company.
28.
A health care program serving active duty service members, members of the National Guard, reitrees, their families, survivors, and selected former spouses worldwide.
29.
The period of time that an individual must wait to become eligible for insurance coverage before coverage commences or for a specific benefit; also known as an elimination period.
