Learn about the role of the Pharmacy and Therapeutics Committee (P&T) in health insurance, how it influences prescription drug use, and its importance to health plans.
Learn about the term 'Encounter' in health insurance, which refers to a meeting with a healthcare provider where the insured receives any type of service.
Learn about National Health Insurance, a system established by federal governments to cover nearly all citizens, and funded through tax money. Explore how this applies to the United States.
Learn about Preferred Provider Organization (PPO) networks in health insurance, how they operate, and their benefits compared to HMO plans. Discover the flexibility PPOs provide for choosing healthcare providers.
Learn about utilization review in health insurance, a crucial process for controlling medical costs by monitoring the quality, necessity, and appropriateness of healthcare services. Understand how employers and insurance companies utilize this process to ensure optimal care.
Discover how hospital alliances work in health insurance, enabling multiple hospitals to share services and reduce costs, helping them stay competitive in the healthcare market.
Learn about the Fee for Service (FFS) reimbursement model in health insurance, where health care professionals are paid based on individual services provided.
Learn about managed health care plans, including how they involve multiple providers sharing financial risks and provisioning medical care services.
Learn about providers in health insurance, including doctors, nurses, and groups who offer medical care and services.
Discover how the Prospective Payment System (PPS) operates in health insurance, particularly with Part A Medicare, and how reimbursement is determined based on patient condition at hospital admission.
Understand what in-area services mean in health insurance, focusing on the health care services provided within a designated geographical area as per the contract terms.
Learn about Professional Corporation, a unit that offers professional services such as healthcare, within the context of general insurance terms.
Learn about Quality Assurance in health insurance, the essential process of reviewing and enhancing the quality of health services and coverage. Discover its importance and methodologies.
Learn what the average semi-private rate means in health insurance. Discover how this charge is determined for semi-private hospital rooms in your area.
Discover how Diagnosis Related Groups (DRGs) are used to determine compensation for medical providers in the health insurance industry.
Learn about prior authorization, a crucial technique in health insurance for minimizing costs by ensuring medical care is pre-approved before benefits are paid.
Learn about utilization management in health insurance, a vital method for assessing the need for various medical services to ensure appropriate care and cost management.
