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Utilization Review 121
Entitlement Program Population
9 other sections not shown
Address and/or assessment authorization basis bill charges claims clinical co-payments concurrent review contract cost containment coverage covered Current procedural terminology deductible diem disability discounted fee arrangement discrepancy dollar amount eligibility employer entitlement programs entity federal fee schedule fee-for-service goals HCFA health care costs health care organization health care providers health care services health insurance health maintenance organization hospital identified indemnity individual inpatient insurance company managed health maximum Medicaid medical necessity Medicare beneficiaries Medicare Select ment negotiation nurse case manager out-of-pocket expenses outcomes outpatient patient payer payment Phone physician services pool preferred provider organization premium prepaid primary care physician procedure purchaser quality assurance RBRVS refers reimbursement arrangement reimbursement verification reinsurance relationship responsible risk salesperson services provided social specialty specific stop loss protection tion traditional treatment utilization management utilization review Y/N Y/N