Such coverage, therefore, has no deductibles or coinsurance. Fixed Asset Property, tangible or intangible, real or personal property, used in the operation of business, not intended for sale, and having a value to the organization and life expectancy in excess of one year. Flagging A Contract A procedure in which an indicator is placed on a member's submaster or Major Medical patient master file in order to pend claims currently being processed or to stop the processing of future claims. A type of benefit program offered by some employers in which employees are presented annually with a number of benefit options, allowing employees to tailor benefits to their specific needs. Formulary A listing of drugs, classified by therapeutic category or disease class, that are considered preferred therapy for a given managed population and that are to be used by an MCO's providers in prescribing medications Fraud Intentional misrepresentation by either providers or consumers to obtain services or payment for services.
Fraud is illegal and carries a penalty when proven.
An institution which is equipped and operated exclusively for the purpose of performing surgical procedures for which patients are scheduled to arrive, receive surgery and be discharged the same day. An ambulatory surgery facility does not include individual or group practice offices of physicians or dentists, unless such offices have a distinct part used solely for outpatient surgical treatment of a regular and organized basis. A licensed outpatient facility which provides for birthing services. A provider licensed and approved by the appropriate governmental agency, which is primarily engaged in providing dialysis treatment, maintenance, or training to members on an outpatient or home care basis. A health care facility that is physically, organizationally, and financially separate from a hospital and whose primary purpose is the provision of immediate, short-term medical care for minor but urgent medical condition.