0 Terms
Home > Industry/Domain > Insurance > Health insurance
Health insurance
Industry: Insurance
Add a new termContributors in Health insurance
Health insurance
bed days
Health care; Managed care
A measurement used by managed care plans to indicate the total number of days of hospital care provided to a member of a health or managed care plan.
age/sex factor
Health care; Managed care
A measurement used in underwriting. It represents the age and sex risk of medical costs of one population relative to another. A group with an age or sex factor of 1.00 is average. A group with an ...
volume performance standards (VPS)
Health care; Managed care
A mechanism to adjust updates to fee-for-service payment rates based on how actual aggregate.
primary care case management (PCCM)
Health care; Managed care
A Medicaid managed care program in which an eligible individual may use services only with authorization from his or her assigned primary care provider. That provider is responsible for locating, ...
qualifying individuals
Health care; Managed care
A Medicaid-sponsored program for those who need assistance paying Part B Medicare health insurance premiums.
cost outlier
Health care; Managed care
A medical case that is more costly to treat compared with other patients in a particular diagnosis-related group. Outliers also refer to any unusual occurrence of cost, cases that skew average costs, ...
qualified medical child support order (QMCSO)
Health care; Managed care
A medical child support order that requires parents to provide health coverage for their children.
