Rule or procedure containing conditional logic for solving a problem or accomplishing a task. Guideline algorithms concern rules for evaluating patient care against published guidelines. Criteria algorithms concern rules for evaluating criteria compliance. Algorithms may be expressions in written form, graphic outlines, diagrams, and flow charts that describe each step in the work or thought process.

Individual not a citizen or national of the United States but belonging to another country or people; a foreigner. May be referred to as an immigrant when a person from another country comes to settle.

Insurance company residing and incorporated under the laws of a foreign country (e.g., Canada, England). Also called alien carrier or alien company.

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An insurance company formed under the laws of a country other than the one it is doing business in.

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US: An insurer domiciled in and licensed under the laws of a country outside a given jurisdiction. For example, from a U.S. perspective, a Bermuda insurer would be an alien insurer.

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An insurer formed under the laws of a different country than the one it operates in.

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An insurer incorporated in a foreign country, doing business in a given state.

Phrase used in a managed care contract to describe the financial arrangements between physicians and hospital facilities that let both parties share in the risks and rewards of controlling costs and increasing income.

Diagnosis-related group (DRG) system that is an enhancement of the original DRGs. It includes groupings for pediatric and maternity cases and services for HIV-related conditions and other special cases.

Insurance policy provision in which the deductible is met by a collection of eligible expenses incurred for any variety of covered claims within a given time period.

In a managed care contract, a flat fee charged daily by a facility (per diem rate) or for a total hospital stay. For submitting a Uniform Bill (UB-04) claim, revenue codes are 0100 (all-inclusive room and board plus ancillary) and 0101 (all-inclusive room and board). This is commonly billed by state psychiatric hospitals.