1. Group of physicians and/or providers structured as a sole professional business that is recognized under state law as an entity to practice a medical profession. 2. In a managed care plan, a professional organization of physicians that contracts with a health plan to deliver both primary or basic and special medical care to plan members.

National membership organization that provides information, networking, and professional development for the individuals who manage and lead medical group practices. Its purpose is to improve the effectiveness of medical group practices and the knowledge and skills of the individuals who manage and lead them. It provides its members data on physician compensation, performance efficiency, and medical practice comparisons.

When an individual uses a person’s name and sometimes other parts of the identity such as insurance information without the person’s knowledge or consent to obtain medical services or goods or uses the person’s identity information to make false claims for medical services or goods. Also called identity theft .

Study of storage, retrieval, analysis, and communication of biomedical and clinical information to improve medical decision-making by physicians and managers of health care organizations. Also referred to as medical information science and informatics .

Data needed about the onset and history of a specific illness so that a managed care plan may establish if benefits are available for treatment.

Nonstock, nonprofit membership association of life insurance companies of the United States and Canada that provides information and database management services to the financial services industry. Organized in 1902, MIB’s core fraud protection services protect insurers, policyholders, and applicants from attempts to conceal or omit information material to the sound and equitable underwriting of life, health, disability, and long-term care insurance. Fair pricing of insurance products is dependent on accurate “risk assessment,” “risk classification,” and “risk selection.” A determination of these factors begins with the assurance of accurate health information supplied on the insurance application concerning the proposed insured.

Employee who works for a physician or in a health care facility and handles source documents, codes procedures and diagnoses, processes insurance claims, and follows up on delayed reimbursement and delinquent accounts. Also known as an insurance claims processor, medical biller , or reimbursement specialist . Also see insurance billing specialist.