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and/or authorization benefit package bill capitation claims clinical co-payments consumer contain costs contract cost containment coverage Current procedural terminology deductible defined diem disability discounted fee arrangement discrepancy dollar amount eligibility employer entitlement programs entity expenses federal fee schedule fee-for-service goals group practice HCFA health care costs health care organization health care providers health care services health insurance health maintenance organization Health Plan HMO models hospital identified indemnity individual inpatient insurance company managed health Medicaid medical necessity Medicare beneficiaries Medicare Select ment negotiation nurse case manager organization model out-of-pocket expenses outpatient patient payer payment Phone physician groups physician services pool preferred provider organization premium primary care physician procedure purchaser quality assurance RBRVS referred reimbursement arrangements Reinsurance relationship risk salesperson services provided Social staff model stop loss protection tion treatment utilization management utilization review Y/N Y/N