Field positions 1 through 81 on the Uniform Bill (UB-04) paper or electronic claim form for specific billing and coding information. Every FL accepts a certain number of characters, alphabetic or numeric and symbols or spaces. For some insurance carriers, FLs may be required, preferred, or optional, depending on the data.

Authorization request (telephone, fax, or completed form) required by the managed care organization contract to determine medical necessity and grant permission before services being rendered or procedures performed.

1. Organization or appearance of data. 2. Under the Health Insurance Portability and Accountability Act (HIPAA), this relates to those data elements that provide or control the enveloping or hierarchical structure, or assist in identifying data content of a transaction.

1. List of drugs shown in therapeutic or disease categories. 2. In some insurance plans, managed care plans, or Medicare Part D plans, providers are limited to prescribing medications to members from a list of drugs and dispensed through pharmacies participating in the plan. Most plans’ formularies include the most common drugs prescribed for seniors. Also called drug formulary, preferred-drug list (PDL) , or select drug list .
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–A list of drugs that are covered by a particular insurance plan. Formularies often contain different tiers of coverage between which levels of coverage and out-of-pocket expenses can vary considerably.

List of prescribed medications recommended by a managed care plan and dispensed by participating pharmacies to members (enrollees) of the plan. It is periodically reviewed and modified. See the three types—open, closed, and restricted formularies—for information. See formulary and drug formulary .