Required membership in a program (e.g., Medicaid managed care, Medicare Part D).

List of surgical procedures that should be performed as an outpatient to reduce unnecessary inpatient hospital admission.

Liability account designed to absorb, within specified limits, realized and unrealized gains and losses that result from an insurance company’s investments.

Outlay of funds for entitlement programs such as Medicare and Medicaid that are not subject to the federal appropriations process.

Medical services not covered by Medicare that enrollees must purchase as a condition of enrollment in a Medicare Advantage Plan. Usually those services are paid for by premiums and/or cost sharing. Mandatory supplemental benefits can be different for each Medicare Advantage Plan. Medicare Advantage Plans must ensure that any particular group of Medicare beneficiaries does not use mandatory supplemental benefits to discourage enrollment.

Characteristic signs or symptoms associated with an illness.

Reduction or correction of a fracture or joint dislocation by applying manual force to move it into its normal anatomical position or alignment.

Book published by an insurance company or rating bureau that is used as a guide. It contains rates, classifications, specifications, and rules pertaining to various types of insurance policies.
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A guide to rates and classifications under a certain type of insurance.

Processing statements by hand; may involve typing statements or photocopying the patient’s ledger and placing it in a window envelope, which then becomes the statement.

Physical analysis of an insurance claim, prepayment or postpayment, that requires the intervention of program safeguard contractor (PSC) personnel.