|
Glossary
A
|
B
|
C
|
D
|
E
|
F
|
G
|
H
|
I
|
L
|
M
|
N
|
O
|
P
|
Q
|
R
|
S
|
T
|
U
|
V
|
W
|
Y
|
ALL
Here are definitions of some of the terms that are used throughout the site.
Usual, Customary and Reasonable (See MG): A "usual" charge is the amount that is most consistently charged by an individual physician for a given service. A "customary" charge is the amount that falls within a specified range of usual charges for a given service billed by most physicians with similar training and experience within a given geographic area. A "reasonable" charge is a charge that meets the Usual and Customary criteria, or is otherwise reasonable in light of the complexity of treatment of the particular case. Under a UCR Program, the payment is the lowest of the actual billed charge, the physician's usual charge or the area customary charge for any given covered service.
Urgent Care: Services provided for a condition that occurs suddenly and unexpectedly, requiring prompt diagnosis or treatment, such that in the absence of immediate care the individual could reasonably be expected to suffer chronic illness, prolonged impairment or require a more hazardous treatment. Examples of urgent care include sprains, some lacerations and dizziness.
User Name: The name of the person(s) who will have a Blue e account (a user name, login ID, and password).
Utilization Management: A process of integrating review and case management of services in a cooperative effort with other parties, including members, groups, providers and payers to optimize the appropriate placement of patients to receive appropriate services/supplies.
Utilization Review: Evaluation of the necessity, appropriateness, and efficiency of the use of medical services, procedures and facilities.
|
