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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.
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 ...
The Commission on Dental Competency Assessments (formerly the North East Regional Board of Dental Examiners) is one of three examination agencies for dentists in the United States. [1] These were organized to better standardize clinical exams for licensure. Historically each state had its own independent licensing exam.
Another near-universal feature is a pre-certification requirement, in which scheduled (non-emergency) hospital admissions, and in some instances, outpatient surgery, must have the prior approval of the insurer and must often undergo "utilization review" in advance. [5]
Specialty services require a specific referral from the PCP to the specialist. Non-emergency hospital admissions also require specific pre-authorization by the PCP. Typically, services are not covered if performed by a provider not an employee of or specifically approved by the HMO unless it defines the situation to be an emergency.
National Board Dental Examination (NBDE) is the United States national dental examination for students and professionals in dentistry. It is required for licensure in the United States and may also be required when applying for postgraduate studies in dental specialities after completing a dental degree .
Central Regional Dental Testing Service (CRDTS) is one of five examination agencies for dentists in the United States. The other examination agencies are, West Regional Examining Board , Northeast Regional Board of Dental Examiners , Southern Regional Testing Agency , and Council of Interstate Testing Agencies .
The Health Maintenance Organization Act of 1973 (Pub. L. 93-222 codified as 42 U.S.C. §300e) is a United States statute enacted on December 29, 1973. The Health Maintenance Organization Act, informally known as the federal HMO Act, is a federal law that provides for a trial federal program to promote and encourage the development of health maintenance organizations (HMOs).