Twelve consecutive months starting with the beginning date of coverage; this period may not always coincide with a calendar year.
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This period runs from the effective date to the expiration of the contract.

Those covered insurance benefits provided by the physician that are consistent with the physician’s training, licensor, and scope of practice.

Facility that has a legal agreement with a managed care plan to provide specific hospital services to members of the plan.

1. See insurance carrier. 2. See fiscal agent. 3. See fiscal intermediary. 4. See durable medical equipment regional carrier (DMERC). 5. See regional home health intermediary (RHHI). 6. See program safeguard contractor (PSC). Also known as insurer or carrier.

Policy developed by Centers for Medicare and Medicaid Services (CMS) contractors (fiscal intermediary or carrier, affiliated contractor, provider service carrier) and used to make coverage and coding determinations. It is developed when there is an absence of national coverage policy for a service or all of the uses of a service; there is a need to interpret national coverage policy; or there is a need for local coding rules.

Difference between the allowed amount and the billed amount that is credited to an account as agreed upon in the insurance contract with the provider of service.

System of making hospital payments through a formal agreement with an insurance payer to accept for a patient or group of patients a discounted amount instead of actual fees as full payment for medical services.