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Definitions; All Managed Care Programs | Midpage
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Indiana Administrative Code
Title 405
14
Rule 2
Definitions; All Managed Care Programs
Office of the Secretary of Family and Social Services
1
Applicability
2
"Adverse action" defined
3
"Aligned enrollment" defined
4
"American Indian/Alaska Native" defined
5
"Appeal" defined
6
"Capitated payment" defined
7
"CHIP" defined
8
"Choice counseling" defined
9
"Claim" defined
10
"Clean claim" defined
11
"Code of Federal Regulations" or "CFR" defined
12
"Contract" defined
13
"Covered service" defined
14
"Credentialing" defined
15
"Day" defined
16
"Disenrollment" defined
17
"Dual eligible member" defined
18
"Emergency medical condition" defined
19
"Emergency services" defined
20
"Enrollee" defined
21
"Enrollment broker" defined
22
"Federally qualified health center" or "FQHC" defined
23
"Fee-for-service" or "FFS" defined
24
"Grievance" defined
25
"Health and wellness waiver" or "H&W waiver" defined
26
"Health maintenance organization" or "HMO" defined
27
"Healthy Indiana Plan" or "HIP" defined
28
"Home and community based services" or "HCBS" defined
29
"Hoosier Care Connect" or "HCC" defined
30
"Hoosier Healthwise" or "HHW" defined
31
"Indiana health coverage programs" or "IHCP" defined
32
"Intermediate care facility for individuals with intellectual disabilities" or "ICF-IID" defined
33
"Level of care assessor" or "LOCA" defined
34
"Managed care organization" or "MCO" defined
35
"Managed care program" defined
36
"Managed long term services and supports" or "MLTSS" defined
37
"Mandatory enrollment" defined
38
"Medicaid rehabilitation option" or "MRO" defined
39
"MED Works" defined
40
"Member" defined
41
"PathWays" or "Indiana PathWays for Aging" defined
42
"Primary medical provider" or "PMP" defined
43
"Poststabilization care services" defined
44
"Prior authorization" defined
45
"Qualified disabled working individual" or "QDWI" defined
46
"Qualified Medicare Beneficiary-Also" or "QMB-Also" defined
47
"Qualified Medicare beneficiary dual eligible member" or "QMB DUAL" defined
48
"Qualified Medicare beneficiary only" or "QMB Only" defined
49
"Qualified Medicare beneficiary plus" or "QMB Plus" defined
50
"Qualifying individual" or "QI" defined
51
"Referral" defined
52
"Self-referral" defined
53
"Specified low income Medicare beneficiary only" or "SLMB Only" defined
54
"Specified low income Medicare beneficiary plus" or "SLMB+" defined
55
"State plan" defined
56
"Supplemental security income" or "SSI" defined
57
Enrollment area
58
Grievances and appeals
59
Enrollment and disenrollment
60
PMP selection and assignment
61
Drug coverage