a. A provider who is participating in the plan.|
b. A group of providers, who pool resources and contract with payers at a
discounted fee-for-service or a capitated rate.
c. Provides coverage for physician and outpatient services.
when the wound is superficial. This includes partial or full thickness damage to
the skin and/or subcutaneous tissues. Deeper structures are not involved.
e. Key components are: history, examination and medical decision making.
f. The insurer that reimburses for benefits pending after the primary insurer
g. Coverage for hospital, nursing home, home health and inpatient care.
h. A plan contracting with providers to provide
services on a discounted basis. Members must stay within the plan or pay a
i. A statement mailed to both the patient and the provider explaining claim
adjudication and payment.
j. Primary Care Physician