Search results
Results from the WOW.Com Content Network
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual.
Malice aforethought is the "premeditation" or "predetermination" (with malice) required as an element of some crimes in some jurisdictions and a unique element for first-degree or aggravated murder in a few. [1] Insofar as the term is still in use, it has a technical meaning that has changed substantially over time.
While there are differences between getting preapproved vs. prequalified, both processes usually involve credit checks: a soft check for prequalification and a hard check for preapproval.
Verification is intended to check that a product, service, or system meets a set of design specifications. [6] [7] In the development phase, verification procedures involve performing special tests to model or simulate a portion, or the entirety, of a product, service, or system, then performing a review or analysis of the modeling results.
In the context of healthcare in the United States, a pre-existing condition is a medical condition that started before a person's health insurance went into effect. Before 2014, some insurance policies would not cover expenses due to pre-existing conditions.
Predeterminism is the philosophy that all events of history, past, present and future, have been already decided or are already known (by God, fate, or some other force), including human actions.
Difference in differences (DID [1] or DD [2]) is a statistical technique used in econometrics and quantitative research in the social sciences that attempts to mimic an experimental research design using observational study data, by studying the differential effect of a treatment on a 'treatment group' versus a 'control group' in a natural experiment. [3]