Facility under contract with a managed care plan to provide medical services to members of the plan. In an emergency situation, a member can save money by using a designated hospital instead of one that is not designated in the plan.

Facility or physician hired by a health plan to provide mental health and substance abuse services.

Individual or location authorized by a managed care plan to give mental health and substance abuse care to the plan’s members.

Under the Health Insurance Portability and Accountability Act (HIPAA), a group of records maintained by or for a covered entity that is (1) the medical records and billing records about individuals maintained by or for a covered health care provider; (2) the enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or (3) used, in whole or in part, by or for the covered entity to make decisions about individuals.

Standard that Health and Human Services (HHS) has designated for use under the authority provided by the Health Insurance Portability and Accountability Act (HIPAA).

Association chosen by the Secretary of the United States Department of Health and Human Services to maintain standards adopted under Subpart 1 of 45 Code of Federal Regulations Part 162. A DSMO may receive and process requests for adopting a new standard or modifying an adopted standard.