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  2. Medical billing - Wikipedia

    en.wikipedia.org/wiki/Medical_billing

    Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed.

  3. Balance billing - Wikipedia

    en.wikipedia.org/wiki/Balance_billing

    Balance billing, sometimes called surprise billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays. [1]

  4. Usual, customary and reasonable - Wikipedia

    en.wikipedia.org/wiki/Usual,_customary_and...

    The US government healthcare website defines usual, customary and reasonable as being "The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount."

  5. 340B Drug Pricing Program - Wikipedia

    en.wikipedia.org/wiki/340B_Drug_Pricing_Program

    Moreover, the number of unique pharmacies serving as 340B contract pharmacies has grown by 770 percent, and the total number of contract pharmacy arrangements has grown by 1,245 percent. (2) 340B contract pharmacy arrangements create complications in preventing diversion, and covered entities are addressing these complications in different ways.

  6. Specialty drugs in the United States - Wikipedia

    en.wikipedia.org/wiki/Specialty_drugs_in_the...

    In their 2001 annual report, CVS anticipated that the "$16 billion specialty pharmacy market" would grow at "an even faster rate than traditional pharmacy due in large part to the robust pipeline of biotechnology drugs". [34] By 2014 CVS Caremark, Express Scripts and Walgreens represented more than 50% of the specialty drug market in the United ...

  7. Pharmacy benefit management - Wikipedia

    en.wikipedia.org/wiki/Pharmacy_benefit_management

    Under these laws, pharmacy benefit managers with contracts to Health care service plans are required by law to be registered with the Department of Managed Health Care to disclose information. [58] SB 966: Pharmacy benefits. SB 966: Pharmacy benefits is a California state bill written by state senators Aisha Wahab and Scott Weiner. It is ...