Glossary
Tags
- ACA
- ACA Marketplace
- ACA subsidies
- CHIP
- CMS
- ESRD
- Extra Help
- FMAP
- FPL
- FQHC
- FSA
- HCBS
- HMO
- HRA
- HSA
- IEP
- IRMAA
- Joint Commision
- KFF
- LCD
- LIS
- Marketplace
- Medicaid
- Medicaid (rare)
- Medicaid expansion
- Medicare
- Medicare Advantage
- Medicare Part A
- Medicare Part B
- Medicare Part D
- Medicare coordination
- Medigap
- NCD
- NEMT
- NOMNC
- Original Medicare
- PCP
- Part A
- Part B
- Part C
- Part D
- QLE
- QMB
- SEP
- SNF
- SNP
- SSI
- Section 1115
- Silver Plan
- Silver plan
Prior Authorization
A requirement that certain healthcare services or medications must be approved by the health insurance provider before they are provided. Medicare, Medicaid, and ACA plans may require prior authorization for procedures or high-cost drugs.
A requirement that certain healthcare services or medications must be approved by the health insurance provider before they are provided. Medicare, Medicaid, and ACA plans may require prior authorization for procedures or high-cost drugs.
Utilization Management
A process used by health insurance providers to evaluate the necessity and efficiency of healthcare services. It includes practices like prior authorization, step therapy, and case reviews to ensure appropriate use of medical resources. Common in Medicare Advantage, Medicaid, and ACA plans.
A process used by health insurance providers to evaluate the necessity and efficiency of healthcare services. It includes practices like prior authorization, step therapy, and case reviews to ensure appropriate use of medical resources. Common in Medicare Advantage, Medicaid, and ACA plans.