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Insurance credentialing / medical credentialing. Credentialing is the process the healthcare facility or managed care organization/health plan uses to collect and verify the “credentials” of the applicant. This includes verification of many elements including licensure, education, training, experience, competency, and judgment.
v. t. e. In the United States, an independent practice association ( IPA) is an association of independent physicians, or other organizations that contracts with independent care delivery organizations, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis.
Prior authorization is a check run by some insurance companies or third-party payers in the United States before they will agree to cover certain prescribed medications or medical procedures. [1] There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic ...
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: the payee, the ...
Mutual insurance. A mutual insurance company is an insurance company owned entirely by its policyholders. It is a form of consumers' co-operative. Any profits earned by a mutual insurance company are either retained within the company or rebated to policyholders in the form of dividend distributions or reduced future premiums.
Dental insurance is a form of health insurance designed to pay a portion of the costs associated with dental care. American dental insurance [ edit ] The American Dental Association has lobbied against the US government providing dental insurance coverage for all Medicare recipients.
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