Diagnosis-related group (DRG) system that is an enhancement of the original DRGs. It includes groupings for pediatric and maternity cases and services for HIV-related conditions and other special cases.

Insurance policy provision in which the deductible is met by a collection of eligible expenses incurred for any variety of covered claims within a given time period.

In a managed care contract, a flat fee charged daily by a facility (per diem rate) or for a total hospital stay. For submitting a Uniform Bill (UB-04) claim, revenue codes are 0100 (all-inclusive room and board plus ancillary) and 0101 (all-inclusive room and board). This is commonly billed by state psychiatric hospitals.

State system that helps in determining equal uniform prices on medical and hospital services across all providers and all public and private payers, for instance, a common fee schedule. Also referred to as all-payer system.

1. Health insurance purchasing entity (public or private) that enrolls subscribers or members within a given region, collects premiums, enforces rules that manage health plans, and purchases subscribers’ or members’ insurance from participating health plans. 2. Organization or group of employers that pools resources to buy health care goods and services. Also known as a purchasing group . See consumer health alliances. 3. Formal, mutual arrangement of companies, providers, or institutions, established to further common goals.

Health care provider who is not licensed as a doctor of medicine or osteopathy (e.g., nurse practitioner, physician assistant, chiropractor, medical assistant).

Type of property insurance that may be purchased with a fire insurance policy.

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A term that has been adopted to refer to the lines of insurance that are allied with property insurance, these coverage provide protection against perils traditionally written by fire insurance policies such as sprinkler leakage, water damage and earthquake.

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Allied lines coverage is a form of insurance that is normally written with fire insurance. It covers additional perils not usually covered by the basic fire insurance policy. Examples of allied lines insurance include wind and hail insurance, vandalism and malicious mischief insurance, data processing insurance, demolition insurance, earthquake insurance, water damage insurance (but not flood), sprinkler leakage insurance, radioactive contamination insurance, and standing timber insurance. (See Extended Coverage).