Medical Industry Definitions:

Here are some of the common terms used on the site. Health plans, doctors, and hospitals provide some of this information on their application when they join our network. We make updates within 30 days of learning about a change. The health plan checks this content at least every 3 years.

Accepting New Patients:

Shows if the doctor is taking new patients at the office. Some doctors may not have room in their schedules for new patients. We try to keep this updated, but it can change often. It is best to check with the office. The doctor tells us this on the application. We confirm the information with the office.

Accessible to People with Disabilities:

Shows if the office has no barriers. For example, can be used by a person in a wheelchair.

Additional Languages:

Languages other than English are spoken by the doctor or office staff. We rely on the doctor office for this information. Need a doctor who speaks another language? Call the health plan. We can help.

Address, Hours, and Phone Numbers:

The doctor or hospital gives us their contact details. They don’t always let us know of a change right away. It is best to call to confirm.

Age Limitations:

The youngest and oldest age the doctor treats. The doctor tells us this on the application.

Board Status:

Doctors tell us if they have a certificate in a health field. We check that the doctor passed the test for their specialty. A certification may expire. To find out if a doctor is board certified:

• • Go to http://www.abms.org and click on "Is Your Physician Certified."
• • Call 1-866-ASK-ABMS (1-866-275-2267)
• • Visit http://doctorsthatdo.org for a Doctor of Osteopathic Medicine (DO)

Facility Accreditation:

Shows that a facility meets rules for quality and safety. The hospital gives us the report. We check the data with the external group that did the review.

Gender:

Doctors state their gender on the application. We show if they are male, female, or other.

Gender Limitation:

The doctor may only see patients of one sex. The doctor tells us this on the application.

Group Affiliation:

The group or practice the doctor works with. The doctor may be part of several groups or clinics. The doctor tells us this on the application. We confirm that it is accurate.

Hospital Affiliation:

Doctors tell the hospitals where they can see patients.

Hospital Quality Data:

Ratings that show the safety and quality of care at the hospital. Data is reported by the hospital. We provide a link to the rating. We use the site to check the hospital’s performance at least once a year.

Name:

The name of the doctor or hospital. We get this information from their application to join our network.

Practitioner:

The person who is providing care or a service to the member. For example, the doctor, nurse, etc.

Provider:

The place where the member gets service. For example, the hospital, clinic, etc.

Specialties:

Areas of medicine or surgery where doctors provide care. Doctors list this information on their application. We confirm the information.

Telehealth (or Telemedicine):

When you can't meet in person with your doctor, you can still get care.

• • Audio Visit - Talk over the phone
• • Video Visit - See, talk, and chat using a computer, tablet, or smartphone

Check with your doctor to see what services you can get when you can’t go to your doctor's office.

Telehealth Participant (Receiving Site):

The place where the doctor calls from for a video visit.

Telemedicine Participant (Participant Site):

The place where the member calls from for a video visit.

Telemonitoring:

A way you can work with your doctor between visits. While at home, you can use a device to check the progress of your health over a set time. The device sends the data to your doctor. You can talk with your doctor about your results.