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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Predestination asserts that a supremely powerful being has, in advance, fixed all events and outcomes in the universe; it is a famous doctrine of the Calvinists in Christian theology. Likewise, the doctrine of fatalism already explicitly attributes all events and outcomes to the will of a (vaguer) higher power such as fate or destiny.
After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual.
Certification is a comprehensive evaluation of a process, system, product, event, or skill, typically measured against some existing norm or standard.Industry and/or trade associations will often create certification programs to test and evaluate the skills of those performing services within the interest area of that association.
Predestination, in theology, is the doctrine that all events have been willed by God, usually with reference to the eventual fate of the individual soul. [1] Explanations of predestination often seek to address the paradox of free will, whereby God's omniscience seems incompatible with human free will.
The NCPDP Telecommunications standard includes transactions for eligibility verification, claim and service billing, predetermination of benefits, prior authorization, and information reporting, and is used primarily in the United States. Edig@s (EDIGAS) is a standard dealing with commerce, transport (via pipeline or container) and storage of gas.
Preapproval vs. prequalification: How they compare — and where they differ. Prequalification. Preapproval. Purpose. Establishes your homebuying budget as a first step before you shop.
Theological determinism is a form of predeterminism which states that all events that happen are pre-ordained, and/or predestined to happen, by one or more divine beings, or that they are destined to occur given the divine beings' omniscience.
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