Under the Health Insurance Portability and Accountability Act (HIPAA), this is a document signed by the patient that is necessary for use and disclosure of protected health information (PHI) that is not included in any existing consent form agreements.

Approval number given to a provider who requests a specific service, treatment, test, or procedure. It does not guarantee payment if the insurance claim does not establish medical necessity and appropriateness of the care requested for a patient.

1. Individual who is a direct owner of 5% or more of a provider (e.g., business partner, chairman of the board, chief financial officer, chief executive officer, president). 2. Person to whom the provider gives legal authority to be enrolled in the Medicare program. The authorized official can make changes or updates to the provider’s status in the Medicare program and signs a statement that the provider will abide by the laws and regulations of Medicare.

Physician, other individual authorized provider of care, hospital, or supplier who meets the licensing and certification requirements, practices within the scope of that license, and is approved by TRICARE to provide medical care and supplies.