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Prior authorization, or preauthorization, [1] is a utilization management process used by some health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or medication.
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
Insurance Plan Description 111 Individual Insurance Policy and Client Information 112 Property Damage Report 124 Vehicle Damage 148 Report of Injury, Illness or Incident 186 Insurance Underwriting Requirements Reporting 187 Premium Audit Request and Return 252 Insurance Producer Administration 255 Underwriting Information Services 256
The amount that is paid by the insurance is known as an "allowed amount". [19] For example, although a psychiatrist may charge $80.00 for a medication management session, the insurance may only allow $50.00, and so a $30.00 reduction (known as a "provider write off" or "contractual adjustment") would be assessed.
The Tax Relief, Unemployment Insurance Reauthorization, and Job Creation Act of 2010 (Pub. L. 111–312 (text), H.R. 4853, 124 Stat. 3296, enacted December 17, 2010), also known as the 2010 Tax Relief Act, was passed by the United States Congress on December 16, 2010, and signed into law by President Barack Obama on December 17, 2010. [2]
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In the United States, a third-party administrator (TPA) is an organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity. [1] It is also a term used to define organizations within the insurance industry which administer other services such as underwriting and customer service.
The United States Office of Personnel Management (OPM) is an independent agency of the United States government that manages the United States federal civil service.The agency provides federal human resources policy, oversight, and support, and tends to healthcare (), life insurance (), and retirement benefits (CSRS and FERS, but not TSP) for federal government employees, retirees, and their ...
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