System of payment used by a managed care plan in which a specialist provider is paid a fixed, capitated fee for giving medical services.

Health care services that a medical specialist provides (e.g., cardiologist, dermatologist, orthopedic surgeon).

Flat fee paid to a medical specialist for all medical services or procedures.

Medicare contractor who performs a limited Medicare function such as coordination of benefits and statistical analysis.

Medical facility that provides health care services for specific illnesses or diseases (e.g., psychiatric hospital, rehabilitation hospital, long-term care hospital [LTCH]).

Type of Medicare Advantage Plan that provides more focused health care for some people. These plans give all the Medicare health care, as well as more focused care to manage a disease or condition such as congestive heart failure, diabetes, or end-stage renal disease (ESRD).

In a workers’ compensation case, injury occurring as the result of one incident or exposure that causes disability or need for medical treatment.

Medical insurance plan that pays when an individual’s claim reaches a certain threshold chosen by the employer. After the threshold is attained, the stop-loss insurance policy pays claims up to the lifetime limit per employee.

List of qualifying factors of a specific group of individuals, insurance coverage, and services that an insurance company assembles to administer and manage a group insurance program.