This is insurance that employers are required to have to cover medical care of employees who get sick or are injured on the job.

This is a process of tracking, reviewing and rendering opinions about care. The practices of pre-certification, recertification, retrospective review and concurrent review all describe utilization rev [..]

Usual, customary and reasonable charges reflect the prevailing fees for service in an area. Many insurers and managed care plans reimburse providers based on UCR charges. This term may be synonymous w [..]

This is a patient without public or private health insurance. Mayo Clinic requires uninsured patients to make a deposit before receiving care.

The UB92/UB04 form is required by Medicare and Medicaid and used by some private insurance companies and managed care plans for billing inpatient and outpatient hospital or facility charges. The offic [..]

Third-party administrators handle the administrative duties and sometimes utilization review for self-funded plans.

With a tiered product, the member's benefit level of cost sharing is determined by the network of the independently contracted provider that renders the service. Keep in mind that an employer can [..]

If you have supplemental or secondary insurance, Mayo Clinic will submit claims to those carriers on your behalf.

This is any private health insurance plan held by a Medicare or commercial beneficiary, including Medigap policies or post-retirement benefits. Supplemental insurance usually pays the deductible or co [..]

A skilled nursing facility generally is an institution for convalescence or a nursing home. Skilled nursing facilities provide a high level of specialized care for long-term or acute illness.