Impartial panel of physicians who handle complaints by dissatisfied patients or their representatives against doctors.

Process or system in which a dissatisfied patient or participating provider of a managed care plan can express complaints to get a situation resolved. Such procedures include a due process provision and subject these procedures to a specific and standard adjudication method.
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A procedure which allows an insurer or a provider of benefits to express complaints and seek remedies.

Information from a discontented patient or dissatisfied provider transmitted to a managed care plan’s grievance committee to seek remedies for resolution of the problem(s).

Statistic used to evaluate utilization management performance for inpatient, outpatient, partial hospitalization, and so on. Providers in a managed care environment need this information. The formula is to take the gross charges incurred by a specific group for a specific time period and divide it by the average number of members in that group during the same period and then multiply the result by 1000.

Dollar amount that is obtained when converting a provider’s fee schedule that is not based on the resource-based relative value scale (RBRVS) to one that is using only the current fee schedule. Because income is related to the fee for each service and to the frequency performed, this gives only a rough conversion factor. For a more accurate conversion factor formula, see frequency-adjusted conversion factor (FACF) .

Total price of an insurance program for a certain time period such as 1 year before dividends and rate credits are considered.

Statistic used to evaluate utilization management performance for inpatient, outpatient, partial hospitalization, and so on. The formula is to take the gross costs incurred for services received by a specific group for a certain time period and divide it by the average number of covered members in that group during the same period, and multiply the result by 1000. Providers in a managed care environment need this information because it is imperative to keep gross costs per 1000 below collections per 1000.

Total current dollar value of all goods and services produced in the United States during a specific period, usually 1 year, regardless of who supplies the labor or property. GDP differs from the gross national product (GNP) by excluding net income that residents earn abroad. It is the primary indicator of the status of the economy. Formerly called gross national product (GNP) .

In insurance, insureds and their dependents who work for an employer or belong to an association through which they become entitled to insurance coverage.
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Coverage of a number of individuals under one contract. The most common “group” is employees of the same employer.

Retirement plan that provides monthly (or quarterly, semiannual, or annual) income benefits at retirement to a group of individuals that are under a master contract usually issued to an employer. Each member of the annuity plan is given a verifying certificate.