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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.
Provider-sponsored health plans can form integrated delivery systems; the largest of these as of 2015 was Kaiser Permanente. [ 30 ] Kaiser Permanente was the highest-ranked commercial plan by consumer satisfaction in 2018 [ 31 ] with a different survey finding it tied with Humana.
Automatic repeat request (ARQ), also known as automatic repeat query, is an error-control method for data transmission that uses acknowledgements (messages sent by the receiver indicating that it has correctly received a message) and timeouts (specified periods of time allowed to elapse before an acknowledgment is to be received) to achieve ...
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. [1] The EOB is commonly attached to a check or statement of electronic payment. An EOB typically describes:
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. [1] It is an organization that provides or arranges managed care for health insurance , self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care ...
The Federal Security Agency (FSA) was established on July 1, 1939, under the Reorganization Act of 1939, P.L. 76–19.The objective was to bring together in one agency all federal programs in the fields of health, education, and social security.
National Health Fund (NFZ) – Central List of Healthcare Providers (CWŚ) (in Polish) [201] – a public contract list of public and private healthcare providers operating under a contract with the NFZ within the general health insurance system (searchable)
A web portal is a specially designed website that brings information from diverse sources, like emails, online forums and search engines, together in a uniform way. Usually, each information source gets its dedicated area on the page for displaying information (a portlet ); often, the user can configure which ones to display.