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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. d. Performed
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
has paid.
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
greater copay.
i. A statement mailed to both the patient and the provider explaining claim
adjudication and payment.
j. Primary Care Physician
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