| U |
| UB-92
Uniform Bill 1992 |
Top |
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 |
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(1)
The insurance function bearing the risk of
adverse price fluctuations during a particular
period.
(2) 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 |
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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) |
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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 |
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The
frequency with which a benefit is used -- for
example 3,200 doctor's office visits per 1,000
HMO members per a year. Utilization experience
multiplied by the average cost per unit of
service delivered equals capitated costs. |
| Utilization
Review |
Top |
Evaluation
of the necessity, appropriateness, and
efficiency of the use of medical services and
facilities. Helps insure proper use of health
care resources by providing for the regular
review of such area as admission of patients,
length of stay, services performed and
referrals. |
