Physician who graduated from a medical school outside of the United States.

Capability of an insured individual to know beforehand or have possible anticipation that injury would be the result of a specific act or an absent act.
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UK: The test of reasonable foreseeability’ is applied in determining liability in the tort of negligence. The case known as the Wagon Mound (No. 1) made the rule that damage following negligence will not be too remote if it is reasonably foreseeable. Thus foreseeability not directness is the test but see egg shell skull rule.

Unvested amount of money remaining in a retirement plan when a participant is terminated and the employee withdraws the amount vested. When this type of situation occurs, a forfeiture must either be used to reduce the plan sponsor’s future plan contributions or be reallocated to the other participants.
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Loss of a right in consequence of a crime or breach of engagement. Thus, rights under an insurance policy may be forfeited if the claim is fraudulent.

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 .

Organization of physicians sponsored by a state or local medical association concerned with the development and delivery of medical services and the cost of health care. Two types of FMCs exist: (1) comprehensive type of foundation, which designs and sponsors prepaid health programs or sets minimum benefits of coverage; and (2) claims-review type of foundation, which provides evaluation of the quality and efficiency of services by a panel of physicians to the numerous fiscal agents or carriers involved in its area including the ones processing Medicare and Medicaid. Also called foundation or medical foundation .