Kind of association certified by the Department of Workers’ Compensation to provide managed medical care within the workers’ compensation system.

Type of managed care organization that contracts with Centers for Medicare and Medicaid Services (CMS) to provide Medicare-eligible Part B medical services to enrollees. In return for a monthly premium, plus any applicable deductible or copayment, all or most of an individual’s physician services are provided by the HCPP. The HCPP pays for all services it has arranged for (and any emergency services) whether provided by its own physicians or its contracted network of physicians. If a member enrolled in an HCPP chooses to receive services that have not been arranged for by the HCPP, he or she is liable for any applicable Medicare deductible and/or coinsurance amounts, and any balance would be paid by the regional Medicare carrier.

Individual who has been trained in a health-related field, clinical or administrative. The professional may be licensed, certified, or registered by a state or government agency or professional organization or may be an employee of a health care facility.

1. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a person or entity who is trained and licensed to provide care to a patient; also a place that is licensed to give health care such as a hospital, skilled nursing facility, inpatient/outpatient rehabilitation facility, home health agency, hospice program, physician, diagnostic department, outpatient physical or occupational therapy, rural clinics, or home dialysis supplier. Do not confuse this term with insurance companies that provide insurance. 2. Individual who provides medical services, which can include physician, nurse, physician assistant, pharmacist, physical therapist, occupational therapist, speech therapist, and other licensed medical professional persons.

Administrative code set that classifies health care providers by type and area of specialization. The code set will be used in certain adopted transactions. Note: A given provider may have more than one health care provider taxonomy code.

Organization administered by the National Uniform Claim Committee (NUCC) that is responsible for maintaining the provider taxonomy coding scheme used in the X12 transactions. The detailed code maintenance is done in coordination with X12N/TG2/WG15.

Federal legislation that provides liability protection for physicians and hospital facilities who participate in peer review. This act established a national clearinghouse that collects information on physicians who have been sued for malpractice and types of disciplinary actions taken.

Program that supports the mission of the Centers for Medicare and Medicaid Services (CMS) to assure health care security for beneficiaries. HCQIP’s mission is to promote the quality, effectiveness, and efficiency of services to Medicare beneficiaries by strengthening the community of those committed to improving quality; monitoring and improving quality of care; communicating with beneficiaries and health care providers, practitioners, and plans to promote informed health choices; protecting beneficiaries from poor care; and strengthening the infrastructure.

Any health insurance or managed care organization that contracts with physicians to provide hospital and medical services to enrollees on a prepaid basis.