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Glossary

  1. P

    PACE
    See Programs of All-inclusive Care for the Elderly.
    parent company
    A company that owns another company.
    PCCM
    See primary care case manager.
    PCMH
    See Patient-centered medical home.
    PCP
    See primary care provider.
    personal care physician
    See primary care provider.
    pharmaceutical cards
    Identification cards issued by a pharmacy benefit management plan to plan members. These cards assist PBMs in processing and tracking pharmaceutical claims Also known as drug cards or prescription cards.
    PHO
    See physician-hospital organization.
    Plan
    Refers to any Blue Cross and/or Blue Shield Plan.
    Point of Service (POS)
    A healthcare option that allows members to choose medical services as needed, and whether they will go to a provider within the Blue Cross and Blue Shield Plan?s network or seek medical care outside of the network.
    pooling
    The practice of underwriting a number of small groups as if they constituted one large group.
    PPO
    See preferred provider organization.
    pre-existing condition
    In group health insurance, generally a condition for which an individual received medical care during the three months immediately prior to the effective date of coverage.
    preadmission testing
    A utilization management technique that requires plan members who are scheduled for inpatient care to have preliminary tests, such as X-rays and laboratory tests, performed on an outpatient basis prior to admission. .
    precertification
    A utilization management technique that requires a plan member or the physician in charge of the member's care to notify the plan, in advance, of plans for a patient to undergo a course of care such as a hospital admission or complex diagnostic test. Also known as prior authorization.
    prepaid care
    Healthcare services provided to an HMO member in exchange for a fixed, monthly premium paid in advance of the delivery of medical care.
    prescription benefit management plan
    See pharmacy benefit management plan. ?See pharmaceutical cards.
    primary care
    General medical care that is provided directly to a patient without referral from another physician. It is focused on preventive care and the treatment of routine injuries and illnesses.
    primary care physician
    See primary care provider.
    primary source verification
    A process through which an organization validates credentialing information from the organization that originally conferred or issued the credentialing element to the practitioner.
    prior authorization
    In the context of a pharmacy benefit management (PBM) plan, a program that requires physicians to obtain certification of medical necessity prior to drug dispensing. Also known as a medical-necessity review See also precertification.
    prospective review
    The review and possible authorization of proposed treatment plans for a patient before the treatment is implemented.