Examlex
Output controls address how to monitor waste and how to identify who is responsible for data accuracy, report distribution, and end-user controls.
Eligibility for Benefits
Criteria that determine if individuals or groups qualify for certain advantages or services.
Predetermination
The act of deciding or establishing something in advance, often before relevant data or events are known.
Preauthorization
Prior approval of insurance coverage and necessity of procedure; refers to obtaining plan approval for services prior to the patient receiving them; relates not only to whether the services are covered but also whether the proposed treatment is medically necessary.
Medically Necessary
A term used to describe treatments, services, or supplies needed to diagnose or treat a medical condition, determined by healthcare providers.
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