Formal system for physicians to be informed of and participate in the development of local medical review policies (LMRPs) in an advisory capacity. This committee discusses methods to improve administrative policies that are within the insurance carrier’s discretion.

One health insurance company replaces one or more other health insurance carriers for a group client. This process allows merging and combining the experience and risk of the group.

Direct electronic transmission of insurance claims by the physician to the insurance company.

Provision in some medical expense policies in which expenses incurred during the last 3 months of a benefit period or calendar year are used to satisfy the current benefit period’s deductible and may also be used to satisfy any or all of the following benefit period’s (or next year’s) deductible.

Format used when a complete entry does not fit on one line and then drops down to the next line.

1. Medical service not included within the capitation rate as a benefit of a managed care contract and may be contracted for separately. For example, carve-out services might include vision and dental, sometimes called a single-service plan (SSP) . 2. Integrated plan of providing medical coverage to Medicare-eligible employees. See Medicare carve-out.

Insurance coverage for specific health care services available for purchase separately from the basic managed care plan. Also called single-service plan (SSP). Also see Medicare/employer supplemental insurance.

1. A particular instance of injury or disease, as a case of leukemia; sometimes used incorrectly to designate the patient with the disease. 2. Entire plan of a group insurance policyholder.

Past and current clinical information that the physician wants to know about the patient. The case history becomes part of the patient’s health record.