Specialty Plan refers to a type of Medicare Advantage Plan that provides focused healthcare services for beneficiaries with specific diseases, conditions, or healthcare needs. 🧠 Full Definition Specialty Plan is a Medicare Advantage Plan designed to provide specialized healthcare coordination … [Read more...] about Specialty Plan
Plans
Social Health Maintenance Organization (SHMO)
Social Health Maintenance Organization (SHMO) refers to a specialized Medicare health plan that combines standard Medicare HMO coverage with expanded healthcare and supportive care services. 🧠 Full Definition Social Health Maintenance Organization (SHMO) is a specialized type of Medicare … [Read more...] about Social Health Maintenance Organization (SHMO)
Small Health Plan
Small Health Plan refers to a health plan classified under HIPAA as having annual receipts of $5 million or less. 🧠 Full Definition Small Health Plan is a healthcare coverage entity classified under the Health Insurance Portability and Accountability Act (HIPAA) as having annual receipts of $5 … [Read more...] about Small Health Plan
Service Area
Service Area refers to the geographic region where a health plan accepts members and provides covered healthcare services. 🧠 Full Definition Service Area is the defined geographic region in which a health plan enrolls members and delivers covered healthcare services through its provider … [Read more...] about Service Area
Risk-Based Health Maintenance Organization/Competitive Medical Plan
Risk-Based Health Maintenance Organization/Competitive Medical Plan refers to a managed care organization that assumes financial responsibility for healthcare services provided through its approved provider network. 🧠 Full Definition Risk-Based Health Maintenance Organization/Competitive … [Read more...] about Risk-Based Health Maintenance Organization/Competitive Medical Plan
Provider-Sponsored Organization (PSO)
Provider-Sponsored Organization (PSO) refers to a managed care organization operated by healthcare providers rather than by a traditional insurance company. 🧠 Full Definition Provider-Sponsored Organization (PSO) is a managed care organization formed and operated by groups of doctors, … [Read more...] about Provider-Sponsored Organization (PSO)
Programs Of All-Inclusive Care For The Elderly (PACE)
Programs Of All-Inclusive Care For The Elderly (PACE) refers to a community-based healthcare program designed to provide comprehensive medical and supportive services for eligible older adults. 🧠 Full Definition Programs Of All-Inclusive Care For The Elderly (PACE) is a healthcare program that … [Read more...] about Programs Of All-Inclusive Care For The Elderly (PACE)
Private Fee-for-Service Plan
Private Fee-for-Service Plan (PFFS) refers to a Medicare Advantage plan that allows beneficiaries to receive healthcare services from any Medicare-approved provider that accepts the plan’s payment terms. 🧠 Full Definition Private Fee-for-Service Plan (PFFS) is a type of Medicare Advantage Plan … [Read more...] about Private Fee-for-Service Plan
Primary Case Management
Primary Case Management refers to a healthcare program in which primary care providers coordinate and manage medical services for Medicaid beneficiaries. 🧠 Full Definition Primary Case Management is a healthcare coordination program in which states contract directly with primary care providers … [Read more...] about Primary Case Management
Prepaid Health Plan
Prepaid Health Plan refers to a managed care entity that provides healthcare services through prepaid reimbursement arrangements using either risk-based or non-risk payment structures. 🧠 Full Definition Prepaid Health Plan is a managed care organization that delivers healthcare services … [Read more...] about Prepaid Health Plan
Preferred Provider Organization Plan
Preferred Provider Organization (PPO) Plan refers to a Medicare Advantage plan that uses a provider network while allowing beneficiaries to receive out-of-network healthcare services at additional cost. 🧠 Full Definition Preferred Provider Organization Plan is a type of Medicare Advantage Plan … [Read more...] about Preferred Provider Organization Plan
Point-of-Service (POS)
Point-of-Service (POS) refers to a Medicare managed care plan option that allows beneficiaries to receive healthcare services outside the plan’s provider network at additional cost. 🧠 Full Definition Point-of-Service is a Medicare managed care plan option that combines network-based healthcare … [Read more...] about Point-of-Service (POS)
Physician Incentive Plan
Physician Incentive Plan refers to a compensation arrangement between a managed care organization and physicians that may influence healthcare services provided to Medicare or Medicaid beneficiaries. 🧠 Full Definition Physician Incentive Plan is a compensation arrangement established between a … [Read more...] about Physician Incentive Plan
Payer
Payer refers to an entity that assumes financial responsibility for paying healthcare treatment costs and medical services. 🧠 Full Definition Payer is a healthcare financing entity responsible for paying medical treatment costs and healthcare service expenses. Payers may include health … [Read more...] about Payer
Partially Capitated
Partially Capitated refers to a healthcare reimbursement arrangement where certain healthcare services are paid through fixed capitated amounts while other services use cost-based or fee-for-service reimbursement. 🧠 Full Definition Partially Capitated is a managed care reimbursement structure … [Read more...] about Partially Capitated