See: preauthorization. Also See: precertification and predetermination.
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UK:
The granting of tax exempt status by the Inland Revenue Savings, Pensions and Share Schemes Office to pension arrangements that meet the legislative requirements. Members will then be able to set all or part of their pension contributions against their income tax liability. Schemes meeting certain conditions get mandatory (auto matic) approval while in other cases discretionary approval may be given. Most occupational schemes are exempt approved schemes.
Blue Cross and Blue Shield phrase that means the formal notice sent by a host plan from the home plan after the home plan has received the admission wire and verified membership information. This approval is given for a specific number of days and insurance contract benefits. See also admission wire.
1. Maximum dollar value the commercial private insurance company or managed care contract assigns to each procedure or service on which payment is based. Typically, a percent (e.g., 80%) of the allowed amount is paid by the insurance carrier. 2. Allowed amount based on the Medicare fee schedule or its transition rules, which may or may not be the same as the actual amount billed. The patient may or may not be responsible for the difference. Nonparticipating physician charges are subject to the limiting charge. 3. Also called the allowed amount or approved amount. See also Medicare-approved amount, maximum allowable, and maximum allowable charge (MAC).
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Amounts paid under health insurance as the maximum fee for a covered service.
1. Medical facility authorized to provide medical services and specific health care services stated in managed care contracts. 2. Hospital authorized to treat and admit beneficiaries of the Medicare program. Also known as approved health care hospital .
See: approved health care facility.
Medical program certified or endorsed to provide services to members of a managed care plan or beneficiaries of a federal program (e.g., Medicare, TRICARE).
Modifier used by physicians who provide medical services in health professional shortage areas (HPSAs) that became effective January 1, 2006. Previously, two modifiers (QB and QU) distinguished between physicians providing HPSA services in rural areas and those providing HPSA services in urban areas. These are no longer used.
1. HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating a physician scarcity area. Use of this modifier affects Medicare payment. 2. Abbreviation for accounts receivable. See accounts receivable (AR).