Review done after claims of medical and financial records have been submitted by an insurance company or Medicare representative to investigate suspected fraudulent and abusive billing practices (retrospective review).

SubstancePoisoningAccidentTherapeutic UseSuicide AttemptAssaultUndeterminedAcetylsalicylic acid…965.1E850.3E935.3E950.0E962.0E980.0

Release, transfer, or divulging of confidential information beyond the boundaries of the provider health care organization or other entity that collected the data.

Method of using metal pins and an attaching mechanism to hold together the fragments of a fractured bone or for temporary treatment of acute or chronic bone deformity.

1. Federal regulations require states to use an EQRO to review the care provided by capitated managed care entities. EQROs may be a quality improvement organization (QIO) program, another entity that meets peer review organization requirements, or a private accreditation body. 2. Organization with which a state contracts to evaluate the care provided to Medicaid-managed eligibles. Typically, the EQRO is a peer review organization. It may conduct focused medical record reviews targeted at a specific clinical condition or broader analyses on quality. Although most EQRO contractors rely on medical records as the primary source of information, they may also use eligibility data and claims/encounter data to conduct specific analyses.

To surgically remove foreign body, organ, or unwanted tissue from the body.

Provider who participates in TRICARE Extra’s preferred provider network.

System or plan for rating substandard insurance risks in which each substandard class is charged a premium rate that is a certain percentage above the standard premium rate.

A review done after claims of medical and financial records have been submitted by an insurance company or Medicare representative to investigate suspected fraudulent and abusive billing practices (retrospective review).