Physician, other individual authorized provider of care, hospital, or supplier who meets the licensing and certification requirements, practices within the scope of that license, and is approved by TRICARE to provide medical care and supplies.

Type of treatment for cancer in which the patient is his or her own bone marrow donor as compared with allogenic bone marrow transplant in which the donor is another individual.

Claim evaluation and determination made using system logic (edits). Automated claim reviews never require the intervention of a human to make a claim determination.

Computerized claims processing system used in reimbursement of medical, dental, or disability insurance claims.

Third-party administrator (TPA) that receives information from another entity, performs software edits, and redistributes the claims electronically to various insurance carriers in a standard transaction. Also known as clearinghouse .

An interactive voice response system in the Medi-Cal program that allows providers to access recipient eligibility, clear share of cost, and/or reserve a Medi-Service.

Name of an insurance claim reimbursement method that uses computer technology in settling Medicaid claims.

Bank service that permits payment by one check to a number of creditors or direct payment by the bank for specified recurring bills by monthly transfer of funds (e.g., payment of insurance premiums). See also electronic funds transfer system (EFTS) and preauthorized payment. Also called bank check plan, check deposit billing, electronic funds transfer system (EFTS), check-o-matic, preauthorized checking, or preauthorized payment.

Insurance plan choice that automatically pays any premium that is in default at the end of a grace period (usually 31 days). This payment is charged against the insurance policy as a loan, provided the premium is not in excess of the policy’s cash surrender value on the due date of the premium.