They are also referred to as an insurance product, such as professional services, prescription drugs, etc. Clinical information refers to the data contained in the patient record. The data may include such things as problem lists, lab results, current medications, family history, etc. Dependent refers to a person who is affiliated with a subscriber, such as spouse or child. Encounter refers to a meeting between a covered person and a healthcare provider whose services are provided.
Guarantor refers to a person who has financial responsibility for the payment of a patient account.
11.1.3.7 Healthcare provider refers to a person licensed, certified or otherwise authorized or permitted by law to administer health care in the ordinary course of business or practice of a profession, including a healthcare facility. Payor indicates a third party entity who pays for or underwrites coverage for healthcare expenses. Pre-authorization refers to the process of obtaining prior approval as to the appropriateness of a service. Pre-authorization does not guarantee coverage. 11.1.3.10 Primary care provider indicates the provider responsible for delivering care as well as authorizing and channeling care to specialists and other providers in a gatekeeper system.