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  2. National Provider Identifier - Wikipedia

    en.wikipedia.org/wiki/National_Provider_Identifier

    A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...

  3. Insurance Services Office - Wikipedia

    en.wikipedia.org/wiki/Insurance_Services_Office

    ISO was formed in 1971 as an advisory and rating organization for the property/casualty insurance industry to provide statistical and actuarial services, to develop insurance programs, and to assist insurance companies in meeting state regulatory requirements. [4] It became a wholly owned subsidiary of Verisk Analytics in October 2009. [5]

  4. Prior authorization - Wikipedia

    en.wikipedia.org/wiki/Prior_authorization

    There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic alternative, or checking for drug interactions. [ 2 ] [ 3 ] A failed authorization can result in a requested service being denied or in an insurance company requiring the patient to go through a ...

  5. Health care provider - Wikipedia

    en.wikipedia.org/wiki/Health_care_provider

    Health care providers often receive payments for their services rendered from health insurance providers. In the United States, the Department of Health and Human Services defines a health care provider as any "person or organization who furnishes, bills, or is paid for health care in the normal course of business." [1] [2]

  6. After 3 months, Mercy and insurance provider Anthem ... - AOL

    www.aol.com/3-months-mercy-insurance-provider...

    After three months of negotiation, one of Missouri's largest hospital systems and an insurance company have reached an agreement.. More than 2 million Missourians who are insured by Anthem Blue ...

  7. Preferred provider organization - Wikipedia

    en.wikipedia.org/.../Preferred_provider_organization

    In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...

  8. Accountable care organization - Wikipedia

    en.wikipedia.org/wiki/Accountable_care_organization

    An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners.

  9. Unique physician identification number - Wikipedia

    en.wikipedia.org/wiki/Unique_physician...

    A unique physician identification number (UPIN) was a six-character alpha-numeric identifier used by Medicare to identify doctors in the United States. They were discontinued in June 2007 [ 1 ] and replaced by National Provider Identifier , or NPI numbers.