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UnitedHealthcare (UHC) is an insurance and managed care company with four main divisions: UnitedHealthcare Employer and Individual – provides health benefit plans and services for large national employers and individuals. UnitedHealthcare Medicare and Retirement – provides health and well-being services to individuals age 65 and older. [80]
The UHC Foundation is a 501(c)(3) organization that commits to providing quality health supportive services with a variety of resources to enhance the well-being of rural San Joaquin Valley communities. In 1971, UHC originated in the farm working communities where residents expressed the need to have improved access to healthcare.
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 ...
HCUP Logo. The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of healthcare databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).
HEDIS results must be audited by an NCQA-approved auditing firm for public reporting. NCQA has an on-line reporting tool called Quality Compass that is available for a fee of several thousand dollars. It provides detailed data on all measures and is intended for employers, consultants and insurance brokers who purchase health insurance for groups.
United Health Services (UHS) (United Health Services Hospitals, Inc.) is the largest and most comprehensive provider of healthcare services in upstate New York's Southern Tier. [ 3 ] A locally owned, not-for-profit system, it is governed by a volunteer board of directors composed of residents from around the region. [ 4 ]
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]
Shared services is the provision of a service by one part of an organization or group where that service had previously been found in more than one part of the organization or group. Thus the funding and resourcing of the service is shared and the providing department effectively becomes an internal service provider.