Medical care and items such as medical diagnosis and treatment, drugs and biologicals, supplies, appliances, and equipment, medical social services, and use of rural primary care hospital (RPCH) or skilled nursing facilities (SNFs).

1. Contract between any two parties. 2. Under the Health Insurance Portability and Accountability Act (HIPAA), basic agreement between a business associate and a covered entity that describes the business relationship (e.g., a transcription business and a health care provider).

1. Geographical area defined by a managed care plan such as a health maintenance organization (HMO) as the locale in which it will provide health care services to its members directly through its own resources or through arrangements with other providers in the area. Members may be disenrolled if they move out of the plan’s service area. 2. Area where a Medicare private fee-for-service plan accepts members.

Program (e.g., TRICARE) that provides benefits without a contract guaranteeing the indemnification of an insured party against a specific loss; there are no premiums.

Health insurance coverage and/or medical and surgical services without cost limitations to the insured.

Organization that offers data processing of insurance claims and time-sharing services for hospital facilities and physicians.

General description of the types of service provided under the service and/or characteristics that define the service category.

1. Month, day, and year a patient receives a medical service. Dates of service are inserted in Block 24A Lines 1 through 6 of the CMS-1500 insurance claim form. Service date is inserted in Field 45 of the Uniform Bill (UB-04) inpatient hospital billing claim form. The electronic version requires an eight-character date listing year, month, and day: 20XX0328. 2. For health insurance, the effective date of membership. 3. For employment, the effective date of full-time employment.

Special dollar amount given to insurance consultants or brokers who may perform many functions of group representatives or home offices. This occurs when commissions paid to the servicing agent have ceased.