Network provider Any provider in a CCO’s network. If a member sees network providers, the plan pays the charges. Some network – specialists require members to get a referral from their primary care provider (PCP). Non-network provider - A provider who has not signed a contract with the CCO, and may not accept the CCO payment as payment-in-full for their services. Physician services Services that you get from a doctor. – Plan a medical, dental, mental health organization or CCO that pays for its members’ health care services. – Preapproval (preauthorization, or PA) A document that says your plan will pay for a service. Some plans and services require a PA – before you get the service. Doctors usually take care of this. Drugs that your doctor tells you to take. Prescription drugs – Primary care provider or Primary care physician– Also referred to as a this is a medical professional who takes care of your health. They are usually the first “PCP,” person you call when you have health issues or need care. Your PCP can be a doctor, nurse practitioner, physician’s assistant, osteopath, or sometimes a naturopath. Primary care dentist The dentist you usually go to who takes care of your teeth and gums. – Provider Any person or agency that provides a health care service. – Skilled nursing care help from a nurse with wound care, therapy, or taking your medicine. You can get skilled nursing care in a hospital, – nursing home, or in your own home with home health care. Specialist A medical professional who has special training to care for a certain part of the body or type of illness. – Care that you need the same day for serious pain, to keep an injury or illness from getting much worse, or to avoid losing Urgent care – function in part of your body.
Network provider – Any provider in a CCO’s network. If a member sees network providers, the plan pays the charges. Some network specialists require members to get a referral from their primary care provider (PCP). Non-network provider - A provider who has not signed a contract with the CCO, and may not accept the CCO payment as payment-in-full for their services. Physician services – Services that you get from a doctor. Plan – a medical, dental, mental health organization or CCO that pays for its members’ health care services. Preapproval (preauthorization, or PA) – A document that says your plan will pay for a service. Some plans and services require a PA before you get the service. Doctors usually take care of this. Prescription drugs – Drugs that your doctor tells you to take. Primary care provider or Primary care physician– Also referred to as a “PCP,” this is a medical professional who takes care of your health. They are usually the first person you call when you have health issues or need care. Your PCP can be a doctor, nurse practitioner, physician’s assistant, osteopath, or sometimes a naturopath. Primary care dentist – The dentist you usually go to who takes care of your teeth and gums. Provider – Any person or agency that provides a health care service. Skilled nursing care – help from a nurse with wound care, therapy, or taking your medicine. You can get skilled nursing care in a hospital, nursing home, or in your own home with home health care. Specialist – A medical professional who has special training to care for a certain part of the body or type of illness. Urgent care – Care that you need the same day for serious pain, to keep an injury or illness from getting much worse, or to avoid losing function in part of your body.