1. Under a managed care plan or Medicare managed care plan, an opportunity for a member or beneficiary to choose doctors and hospitals outside the plan for an additional cost. 2. Option under TRICARE Prime that allows self-referral for any TRICARE-covered nonemergency services outside the prime network of providers.

Managed care plan in which members are given a choice as to how to receive services, whether through an HMO, PPO, or fee-for-service plan. They may choose a nonparticipating provider (higher cost) or participating provider, with different levels associated with the use of participating providers, and with or without a referral. The decision is made at the time the service is necessary (i.e., “at the point of service”); sometimes referred to as open-ended HMOs, point-of-service (POS) program, swing-out HMOs, self-referral options , or multiple option plans.

Condition resulting from a drug or chemical substance overdose or from the wrong drug or agent given or taken in error.

Generic name for many work groups at Workgroup on Electronic Data Interchange (WEDI) and elsewhere. WEDI is a subgroup of the Accreditation Standards Committee X12 that has been involved in creating electronic data interchange standards for insurance billing transactions.