5 Written questions
5 Matching questions
- Formal referral
- Physician Provider Group (PPG)
- Gatekeeper (Primary care physician)
- a Is a physician who controls patient access to specialists and diagnostic testing services.
- b Physician owned business that has the flexibility to deal with all forms of contract medicine and offers its own packages to business groups, unions and the general public.
- c An authorization request is required by the MCO contract to determine medical necessary, this can be done over the phone, or completed authorization form mailed, transmitted via fax or email.
- d - Exclusive Provider Organization.
- e - Point-of-service Option or Plan
5 Multiple choice questions
- To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.
- Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
- - Health Plan Employer Data Information Set
- - America's oldest privately owned prepaid medical group.
- Card given to each enrollee of a managed care plan include and list patient's the name and member number
5 True/False questions
Preauthorization → A requirement of some health care plans to obtain permission for a service or procedure before it is done and to see whether the insurance program agrees it is medically necessary.
ERISA → - Employee Retirement Income Security Act
UR → Utilization Review
NCQA → - Independent (or Individual) Practice Association.
Tertiary care → Referral of a patient recommended by one specialist to another specialist.