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
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
Private Fee-for-Service Service Area
Private Fee-for-Service Service Area refers to the geographic region where a Medicare Private Fee-for-Service plan accepts members for enrollment. 🧠 Full Definition Private Fee-for-Service Service Area is the defined geographic region where a Medicare Private Fee-for-Service Plan (PFFS) … [Read more...] about Private Fee-for-Service Service Area
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
Preferred Provider Organization
Preferred Provider Organization (PPO) refers to a coordinated care plan that uses contracted provider networks while allowing healthcare coverage both inside and outside the network. 🧠 Full Definition Preferred Provider Organization is a coordinated care health plan that contracts with a … [Read more...] about Preferred Provider Organization
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