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U . . .
Uniform Bill 1992 (UB-92)
Bill form used to submit hospital insurance claims for payment
by third parties. Similar to HCFA 1500, but reserved for the inpatient
component of health services.
Underwriting
One of the following:
- The insurance function bearing the risk of adverse price fluctuations
during a particular period.
- Analysis of a group that is done to determine rates or to
determine whether the group should be offered coverage at all.
A related definition refers to health screening of each individual
applicant for insurance and refusing to provide coverage for pre-existing
conditions.
Urgent Services
Benefits covered in an Evidence of Coverage that are required
in order to prevent serious deterioration of an insured's health
that results from an unforeseen illness or injury.
Usual, Customary, and Reasonable (UCR)
Health insurance plans that pay a physician's full charge if it
is reasonable and does not exceed his or her usual charges and
the amount customarily charged for the service by other physicians
in the area.
Utilization
Use of services. Utilization is commonly examined in terms of
patterns or rates of use of a single service or type of service
such as hospital care, physician visits, prescription drugs. Measurement
of utilization of all medical services in combination is usually
done in terms of dollar expenditures. Use is expressed in rates
per unit of population at risk for a given period such as the
number of admissions to the hospital per 1,000 persons over age
65 per year, or the number of visits to a physician per person
per year for an annual physical.
Utilization Review (UR)
Also known as utilization management or utilization control,
utilization review is a systematic means for reviewing and
controlling patients' use of medical care services as well as the
appropriateness and quality of that care. Usually involves data
collection, review and/or authorization, especially for services
such as specialist referrals, emergency room use, and hospitalization.
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