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Managed Care

Across
When an an applicant with higher risk of utilization chooses a health plan or network provider.
The date upon which something is considered to take effect, which may be a past, present or future date.
One of several way to resolve disputes outside the courts
Unreasonable delay in making an requesting refund or payment
When the provider promises the health plan that it will not offer another health plan equal of better terms before offering those terms or better terms to the first health plan.
Integrated network of physicians
Ambiguity which is apparent on the face of an instrument to any one perusing it, even if unacquainted with the circumstances of the parties
Federal law that sets minimum standards for most voluntarily established health plans for employees in private industry.
Section of the contract with content listed in alphabetical order.
Patient satisfaction survey required by CMS
The negotiated privilege to transfer a right to access a negotiated fee schedule.
Down
When sellers collude to maintain prices at a certain level by agreement among themselves.
Verification of the qualifications of licensed medical professionals and assessing their background and legitimacy
A creditor with preferential rights to payment upon a health plan's bankruptcy.
Leased network of contracted providers who have
Ambiguity that is unclear and not apparent at the analysis stage on contracting.
The refusal of an insurance company or carrier to honor a request by an individual (or his or her provider) to pay for health care services.
Health plan that combines insurance product with provision of services.
In the USA, the generally accepted set of security standards or general requirements for protecting health information.
Price list
Section of a contract that provides a general idea about the contract to its reader such as, what the contract is about, who the parties are, why they are signing a contract.