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P
- PACE
- See Programs of All-inclusive Care for the Elderly.
- parent company
- A company that owns another company.
- Patient Centered Medical Home
- The PCMH is a model of healthcare based on an ongoing, personal relationship between a patient, doctor and the patient's care team. Whatever the medical needs ? primary or secondary, preventive care, acute care, chronic care, or end-of-life care ? the patient has a medical "home"; a single, trusted doctor and care team, through which continuous, comprehensive and integrated care is provided.
- 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.
