This is a auto-generated Article of all your definitions within the glossary.
Glossary
This is a auto-generated Article of all your definitions within the glossary.
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10/5 Rule
Supporting our Behavior Standards, when passing in the hallways, at a distance of 10 feet, make eye contact and smile and at 5 feet, speak and acknowledge.
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90s Club
Departments who score in the 90th percentile for patient satisfaction on the Press Ganey surveys
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ABN
Advanced Beneficiary Notice
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Accreditation
Shows that a health plan meets standards set by an official review committee or organization.
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ACE
Accountable Care Entity
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ACLS
Advanced Cardiac Life Support
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Action Line/ Patient Relations
For patient's feedback on care received at Carle: 383-3333
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Acton
The Russell D. Acton Professional Practice Series - better known as the Acton Conference - is a yearly nursing education event that takes place during Nurses Week.
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Acute Care
Short-term care for an illness or health problem.
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Adjudication
The process of paying or denying claims after comparing them to a member’s benefits.
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ADT
Admission, Discharge, Transfer
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Affordable Care Act (ACA)
A law, as of March 2010, that works to improve the quality of American health care. As of 2014, the ACA requires most people to have health insurance.
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Agency for Healthcare Research and Quality (AHRQ)
Agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.
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AIDET
Five Steps to Achieving Patient Satisfactionhttp://spscarle/sites/carlexp/Pages/AIDET.aspx, A-Acknowledge, I-Introduce, D-Duration, E-Explanation, T-Thank You
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AirLife
Medical air transport service - the helicopter
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Allowed Charge
The most a health plan will pay for a service or procedure.
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ALOS
Average Length of Stay
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AMB/Ambulatory
Outpatient
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Ambulatory Care
Outpatient services, like a lab test or physical therapy. Ambulatory Care Page: 225
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Ancillary Services
Services that fall into diagnostic, therapeutic, or custodial categories. A lab test is an example of a diagnostic service. Speech therapy, physical therapy, and psychotherapy are therapeutic services. Patient care, like home health visits and nursing homes, are custodial services.
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Annual Enrollment Period (AEP) or Annual Election Period
From October 15 to December 7, when you can enroll in Original Medicare, a Medicare Advantage plan, a stand-alone Part D plan, or switch plans.
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Annual Enrollment Period (OEP)
The only time of year you can enroll in an insurance plan, (unless you have Medicare,) from November 15 to January 31.
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Annual Out-of-Pocket Maximum
Once members have paid this amount, we pay 100% of covered expenses for the rest of the benefit period. You will no longer pay copayments or coinsurance, just your monthly premium.
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AP
Accounts Payable
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Appeal
A kind of complaint you make to your health plan about your plan’s benefits, coverage, or payments, like a certain medical service or prescription drug not being covered.
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AR
Accounts Receivable
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Arrow
Emergency/ Ambulance services comprised of paramedics, emergency medical technicians and dispatchers. Since 1963, Carle Arrow Ambulance has been covering the emergency needs of Champaign and Douglas Counties. Arrow operates under the medical direction of Carle Foundation Hospital, the region's Level 1 Trauma Center. Ambulances are stationed in Champaign, Sadorus, Tolono, Tuscola, Urbana and Villa Grove and a paramedic first responder is stationed in Mahomet.
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ASC
Ambulatory Surgery Center
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ASCOM
Internal wireless phone system used in the Carle hospital
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ATLS
Advanced Trauma Life Support
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Auxiliary
Volunteers wearing red jackets and red vests serving in hospitality functions.
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AVS
After Visit Summary Reports
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Behavioral Health Care
Treatment for conditions like depression, eating disorders, and substance abuse.
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Benefit Period
The time period your plan is active for, normally January 1 to December 31.
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BLS
Basic Life Support
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Brand-Name Drug
A prescription drug that’s produced and sold by the same pharmaceutical company that researched and developed it. Brand-name drugs usually cost more, even though they have the same active ingredients as their generic versions.
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Breezeway
Main entry point at hospital on the 1st floor of Center Building. Connects Parkview to North Tower. Contains Info Desk and Starbucks Coffee Shop.
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Broker
A licensed salesperson for health insurance companies.
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CACI
Carle Accountable Care Initiative
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Cafeteria Plan
Plans that include the option for Flexible Spending Accounts (FSAs).
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CAOS
The Carle Auditory Oral School (CAOS) is approved by the Illinois State Board of Education as an educational and therapeutic program for children with hearing loss. CAOS combines children with hearing loss and those with normal hearing in small classrooms to promote speech development.
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CAPL
Carle Academy of Physician Leadership
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CARC
Carle Addiction Recovery Center
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Carle 1st
This pay practice is designed to provide temporary solutions to staffing and scheduling issues in patient care areas when demands exceed our available resources. Carle 1st is a pay practice shift designation assigned to “open” shifts by the unit nurse manager. Carle 1st shifts are designated after the unit nurse manager produces and submits a balanced unit schedule.
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Carle Connect
Website for medical professionals (Carle and Non-Carle)
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Carle Direct
Dedicated transfer nurse specialists are available 24/7 in the Transfer Center to put Carle providers or referring providers in touch with the right physician, expedite a transfer or provide outpatient scheduling. Call (800) 451-4330
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Carle Outpatient Services at The Fields
Building opened in 2019 that houses Oral and Maxillofacial Surgery, Plastic Surgery, Optical, Ophthalmology, Optomery, General Surgey, Ear, Nose and Throat, Audiology and Hearing Services.
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Carle Unite
This pay practice is designed to provide temporary solutions to staffing and scheduling issues in patient care areas when demands exceed our available resources. Carle Unite is a pay practice that may be triggered into effect upon the activation of Hospital Incident Command System (HICS) during orange or red status.
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Case Management
A program that helps members with chronic or complex conditions maintain their care.
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Catastrophic Coverage
When a Medicare member with prescription drug coverage reaches their pharmacy spending maximum and leaves the Coverage Gap, they enter the Catastrophic Coverage Period. During this period, we pay for most of your drug costs.
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Catastrophic Plans
Plans, for people under 30 years old who don’t have access to affordable coverage, with low-cost protection and high out-of-pocket costs.
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CATF
Stands for Carle at The Fields, the location in southwestern Champaign. of Carle's administrative center, outpatient services and the Champaign Surgery Center
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CBISA
Community Benefit Inventory for Social Accountability; software for tracking community benefit, managed by Public Relations
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CBMC
Carle BroMenn Medical Center
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CCA
Carle Clinic Association
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CCU
Critical Care Unit
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CDM
Charge Description Master
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CDU
Critical Decision Unit
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CEH
Carle Eureka Hospital
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Census
A measure of how many patients are currently admitted to the hospital or who are waiting to be assigned a bed. The Capacity Management system assigns a status of Green, Yellow, Orange or Red. Each status has a corresponding staffing, communication, and care management plan so that patient care needs are effectively met when demands exceed and/or stress available resources. Green = Minimal delays in patient flow. No concern Yellow = Some delays in patient flow. Delays could be localized to a particular unit and/or several areas. Orange = Significant delays in patient flow and HICS will be activated. All departments need to be prepared to assist as needed. Red = No beds available. HICS will be activated and all departments need to be prepared to assist as needed.
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Centers for Medicare & Medicaid Services (CMS)
The federal agency that runs the Medicare program and works with states to run Medicaid.
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CERT
Comprehensive Error Rate Testing
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CFAP
Carle Financial Assistance Program
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CFH
Carle Foundation Hospital
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CFPS
Carle Foundation Physician Services
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Champaign Surgery Center at The Fields
Building in southwest Champaign opened in 2019, owned by Carle, and shared with Christie Clinic.
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Charity Care
Carle offers a Community Care Discount Program to provide free or discounted care to those who qualify.http://www.carle.org/Billing/Community-Care-Benefit-Program.aspx
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Children’s Health Insurance Program (CHIP)
Health services for low-income families with children who don't qualify for Medicaid.
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CHOI
Children's Hospital of Illinois
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CHRHC
Carle Hoopston Regional Health Center
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Claim Provisions
Rules for filing claims and for the claims appeals process.
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Clinical Practice Guidelines
The set of standards designed to help doctors make decisions about treating patients.
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CMA
Certified Medical Assistant
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CMC
Carle Main Campus
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CME
Continuing Medical Education. Certified education hours for training and professional development that are required to acheive or maintain licensing.
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CMS
Carle Medical Supply Centers for Medicare & Medicaid Services - US federal agency which administers Medicare, Medicaid, and the State Children's Health Insurance Program. Centers for Medicare and Medicaid Services
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CMSRN
Certified Medical-Surgical Registered Nurse
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COBRA (Consolidated Omnibus Budget Reconciliation Act)
The federal law that lets people buy health insurance for up to 18 months after they lose their job, if the company employed 20 or more people.
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Coinsurance
A set percentage of the total cost of certain medical services covered by the plan that you pay when you use them.
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Comm Center
Communications Center - main switchboard to connect with employees, providers, or patients
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Community Benefit
The way Carle supports and invests in the community ; tracked each year by Public Relations per federal and state law.
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Consumer Assessment of Healthcare Providers and Systems (CAHPS)
Survey that asks consumers and patients to report and evaluate their experiences with health care.
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Continuation
When you lose your health care coverage due to a qualifying event, like a divorce, and are able to keep your coverage for a certain period.
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Coordination of Benefits
Rules that help decide which plan pays first if you have coverage from more than one insurance company.
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Copayment
A set amount you pay each time you see a doctor, fill a prescription or go to the Emergency Department.
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CoPs
CMS's Conditions of Participation
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Cost savings
Strategic Initiative to save on cost and enhance revenue
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COTG
Chicago Office Technology Group - this vendor manages all of Carle's printer and copier machines and supplies
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Couriers
Internal mail delivery
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Coverage Gap
If you have Medicare prescription drug coverage, you enter the Coverage Gap when your total yearly drug costs, both what you and your plan paid, reach a certain amount. During this time, you pay most of your drug costs.
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CPG
Carle Physician Group
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Credentialing
Approval process to make sure doctors and hospitals meet certain standards.
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CRMH
Carle Richland Memorial Hospital
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CSP
Carle Selected Papers
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CT
Carle Tower
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CVICU
Cardiovascular Intensive Care Unit
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Cweb
Legacy Carle intranet with department documents, resources, IT notices, and census updates
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DAISY
Recognition program for nurses that display extraordinary care for patients
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Dependents
A subscriber’s spouse or children covered on the plan.
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Description of Coverage (DOC)
A chart listing a plan's most common benefits.
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DHC
Digestive Health Center
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Direct Marketplace
Where you can shop for all of our individual private plans, which offer more plan, doctor, and drug choices.
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Disease Management
Programs that help people with chronic illnesses better manage their health.
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Diveport
Budgeting software for managers
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DME
Durable Medical Equipment
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DNV GL
DNV Healthcare Inc.-hospital accreditation provider
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Dr. Ike
Ikechukwu L. Uzoaru, MD - The majority of laboratory services provided at the Main Hospital bill out under Dr. Uzoaru.
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Dr. Leonard
James ("Jim") C. Leonard, MD - President & Chief Executive Officer (CEO) of Carle Foundation Hospital.
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DSS
Decision Support Services renamed Information Management & Analytics (IMA)
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Dual Eligibility
People who qualify for both Medicare and Medicaid at the same time. To qualify, you must have Medicare Parts A and B, and you must get Medicaid benefits that pay for all or part of your Medicare copayments, coinsurance, and deductibles.
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Durable Medical Equipment (DME)
Medical equipment that’s prescribed by your doctor for use in your home, like wheelchairs, crutches, hospital beds, oxygen equipment, and walkers.
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DX
Diagnosis
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EAP
Employee Assistance Program
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Ebola Treatment Center
Carle was designated by Illlinois Department of Public Health in 2017
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ECHO
Expanding Childrens' Hearing Opportunities (ECHO) - The Carle ECHO Program offers hands-on learning options for children ages 0–3 and their parents to get a jump start on speech, language and listening skills.
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ED/ER
Emergency Department/ Emergency Room
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Effective Date
A plan’s start date.
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EHR
Electronic Health Record
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EHS
Employee Health Services
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Emergency Care
Care provided in an emergency medical situation where you believe your health is in serious danger, like chest pain, a broken bone, poisoning, shortness of breath, fainting, seizures, and unconsciousness.
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EMMI
The company that makes educational videos for patients to watch prior to having a procedure take place.
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Employee Assistance Programs (EAP)
Programs to help employees balance work and life issues with support and counseling for stress, family, and financial issues.
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EMR
Electronic Medical Record
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EMS
Emergency Medical Services
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EOD
End of Day
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EOM
End of Month or End of Message
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EOP
Emergency Operations Plan
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EOW
End of Week
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EPIC
Electronic Medical Record Software
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ERISA (Employee Retirement Income Security Act)
The law controlling many employer-based health plans that sets rules for pensions and other benefits plans.
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EUIT
East University Information Technology
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Evidence of Coverage
A document you get when you enroll in a Medicare plan, and each fall you remain on that plan, that explains its details, including a complete list of your benefits, the services we cover, and what you pay for each service.
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Exclusions
Conditions or services we will not pay for that are listed in your policy.
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Explanation of Benefits (EOB)
A description of services that lists what we paid.
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FACS
Fellow of the American College of Surgeons
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Family Deductible
The combined dollar amount all family members' expenses must reach before benefits for any member on the plan start.
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FAP
Find a Provider
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Flexible Spending Accounts (FSAs)
Account that lets employees set aside money tax-free from their paychecks for medical expenses. These funds are available for a set benefit period.
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Formulary
A list of drugs covered by your plan that includes generic and brand-name drugs. Our Pharmacy Department and doctors decide what drugs to include based on quality, safety, and how well they work.
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Fully Insured Plan
A health plan where an employer pays a health plan provider to manage the benefits they've chosen.
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Generic Drug
Drugs with the same active ingredients as the brand-name versions that are reviewed and approved by the Food and Drug Administration (FDA). They cost less because their makers don’t have to spend money on research, development, and marketing.
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GEPACS
General Electric Process Automation Computer System
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GME
Graduate Medical Education
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Gold Star
Recognition program for patients to honor employees
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Green/Yellow/Orange/Red
Capactiy levels in the hospital
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Grievance
This is a complaint you make about the quality of care your health plan is giving, like the customer service you received, waiting times, or how an employee acted toward you.
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Group Health Insurance
Coverage through an employer or an organization.
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HA
Hospital Administration or Health Alliance
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Halogen
HR's former performance management system, replaced by PeopleFluent in 2018.
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HAMP
Health Alliance Medical Plans - Insurance provider that is one of the business entities that make up The Carle Foundation. Health Alliance prefers that the HAMP acronym isn't used. Instead please spell out the full name or use Health Alliance.
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HAR
Hospital Account Record
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HB
Hospital Billing
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HCAHPS
Hospital Consumer Assessment of Health Plans Survey - This is a survey used to measure the experience of patients with at least one overnight stay in an inpatient unit. Approximately 25% of the inpatient population will receive an HCAHPS survey. Data compiled from this survey is publically reported.
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HCT
Healthcare Technician
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Healthcare Effectiveness Data and Information Set (HEDIS)
Tool used by more than 90% of America’s health plans to measure performance of care and service.
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Health Reimbursement Arrangement (HRA)
A fund set up and controlled by an employer to help pay for medical expenses not covered by their health plan.
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Health Savings Account (HSA)
Account that lets employees set aside money tax-free for medical expenses. Individuals, employers, and employees can add to these savings accounts. These funds are not on a time limit.
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HICS
Hospital Incident Command System
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High Deductible Health Plan (HDHP)
A plan where you pay higher out-of-pocket costs in exchange for a lower monthly premium.
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HIM
Health Information Management
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HIPAA
Health Insurance Portability and Accountability Act
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HIPAA (Health Insurance Portability and Accountability Act)
A federal law protecting private health information.
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HMO (Health Maintenance Organization)
A plan with personal care from a set network. You’ll need to choose a personal doctor, called a Primary Care Physician (PCP), to manage your care and refer you to specialists. You must go to certain doctors and hospitals, unless it’s an emergency or for urgent care.
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Home Health Care
Medical care, treatment, or skilled care you get in your home.
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Hospice Care
Special care for people who are terminally ill, including medical and physical care and help with social, emotional, and spiritual needs. It also provides support for family and caregivers.
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HSL
High-Succeeding-Low
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HVI
Heart and Vascular Institute
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I-CARE
Illinois Comprehensive Automated Immunization Registry Exchange
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IC-CHART
Former Electronic Medical Record Software
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ICD 10
International Statistical Classifications of Diseases- codes assigned to a diagnosis
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ICU
Intensive Care Unit
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IDPH
Illinois Department of Public Health
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IHA
Illinois Hospital Association
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IMA
Information Management & Analytics
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Initial Enrollment Period (IEP)
A 7-month period, which includes the 3 months before your 65th birthday, the month of your birthday, and the 3 months after your birth month, when you can enroll in Original Medicare, a Medicare Advantage plan, a Stand-Alone Part D plan, or a Medicare Supplement plan for the first time.
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In-Network
The group of doctors, hospitals, pharmacies, and other health care professionals who have agreed to provide services to our members.
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In-Network Pharmacy
Pharmacies that have agreed to provide prescription drugs to our members.
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In-Network Provider
Providers that have agreed to provide services to our members.
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Inpatient Care
The health care services you get when you’re staying in the hospital.
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IPS
Infection Prevention Services
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IR
Interventional Radiology
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ISO
A collection of international quality management standards overseen by the International Organization for Standardization
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ISO 9001
Standards that provide a way to meet and exceed expectations of our patients and reduce variation
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IVS
Invasive Vascular Services
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JCHOA
Joint Commission on Accreditation of Healthcare Organizations
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Krames
Electronic Patient Education System
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Kronos
Timesheet/Payroll Software
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Kudos
Forum for Carle employees to recognize other outstanding employees
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Lawson
Enterprise Resourse Planning software that includes Finance, Supply Chain, Human Resources, Payroll and General Ledger components.
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LDI
Leader Development Institutes
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LDRP
Labor, Delivery, Recovery and Post Partum Unit
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LIS
Laboratory Information System - a component of EPIC
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LMS
Learning Management System
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Long-Term Disability Insurance
Insurance that pays a percentage of your monthly earnings if you become disabled.
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LVAD
Left Ventricular Assist Device
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Magnet
Program that models the standard for excellent patient care.
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Managed Dose Limitation (MDL)
Policy that limits the amount of certain drugs you’re given based on the drug maker’s package size and what the Food and Drug Administration (FDA) recommends.
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Management Forum
Monthly meeting for managers with updates on Carle. (Held 1st Thursday of each month)
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MBCI
Mills Breast Cancer Institute
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McKesson
Vendor Carle utilizes to mail bills; also provides information about returned mail addresses. (See RelayHealth)
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Medicaid
A shared federal and state program that helps people with low incomes pay for medical costs.
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Medicare
The health insurance program run by the Centers for Medicare & Medicaid Services (CMS) for people age 65 and older and some younger than 65 with disabilities.
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Medicare Advantage Plans
Part C plans that are sold by private companies with a Medicare contract that include coverage for both Part A and Part B, and sometimes Part D.
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Medicare Part A (Hospital Insurance)
Helps cover hospital costs like room and board, other inpatient care provided in a hospital or skilled nursing facility, hospice care, and some home health care. Most people don’t have to pay a premium for Part A because they already paid for it through taxes. Part A is included in Original Medicare.
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Medicare Part B (Medical Insurance)
Helps cover medical costs like doctor visits, other outpatient care, and some other medical services Part A doesn’t cover, like physical therapy. With Original Medicare, you can buy Part B for a monthly premium.
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Medicare Part C (Medicare Advantage)
Medicare Advantage plans that are sold by private companies with a Medicare contract that include coverage for both Part A and Part B, and sometimes Part D.
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Medicare Part D Formulary
A list of drugs covered by your Medicare Part D plan that includes generic and brand-name drugs. Our Pharmacy Department and doctors decide what drugs to include based on quality, safety, and how well they work.
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Medicare Part D (Prescription Drug Coverage)
An optional program sold by private companies with a Medicare contract to help cover your prescription drug costs. You can get Part D by buying stand-alone prescription drug plans or Medicare Advantage plans that include Rx coverage.
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Medicare Supplement Plan
A type of Medicare plan that helps cover medical costs Original Medicare doesn’t cover.
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Med Staff Matters
Monthly newsletter for providers with privileges at Carle Foundation Hospital.
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Mental Health Care
Treatment for conditions like depression, eating disorders, and substance abuse. Also called Behavioral Health Care.
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MFS
Maternal Fetal Services
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MOA
Medical Office Assistant
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MSP
Medicare Secondary Payer
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MSPQ
Medicare Secondary Payer Questionnaire
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MyCarle
Secure online record system for patient access.
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MySite
Personal Profile on Carle's intranet - much like an internal Facebook page
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National Committee for Quality Assurance (NCQA)
The NCQA is a non-profit organization dedicated to improving health care quality. They accredit and certify a wide range of health care organizations.
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NICU
Neonatal Intensive Care Unit
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Non-Formulary
Medicine not listed on our formularies. Your doctor needs to request an exception if you need one of these drugs.
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North Clinic Elevators
Located on the north side of University Avenue
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Notice of Privacy Practices
A document that describes how your health plan may use and disclose your health information and your rights regarding this information.
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NRN
No Reply Needed
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Nuc Med
Nuclear Medicine
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Nurse Navigator
A specialty trained registered nurse who serves as patient’s advocate, educator, coordinator and supporter dedicated to improving coordination of care and promote positive outcomes.
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OMFS
Oral and Maxillofacial Surgey
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Onco
Oncology
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OPSAG
Operations Administrator Group - a regular meeting of Senior Leadership
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Optometrist, Ophthalmologist, Optician
Optometrist - usually the primary health provider for normal vision problems and yearly checkups; can treat common vision acuity problems like farsightedness and nearsightedness, can prescribe corrective eyeglasses, contact lenses, dispense and prescribe certain medications, plus test for eye diseases and conditions. Ophthalmologist - can perform the same functions as optometrists, but are considered a higher position as they actually are medical doctors; can diagnose and treat highly complicated eyes issues, can perform surgeries like Lasik and repair retinal damage, and can handle more area specific cases in vision care; generally requires more training than an Optometrist. Optician - specialize in filling the lens prescriptions that optometrists and ophthalmologists prescribe.
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Original Medicare
The health insurance program, made up of Medicare Part A and Part B, run by the Centers for Medicare & Medicaid Services (CMS) for people age 65 and older and some younger than 65 with disabilities.
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Out-of-Network
Doctors, hospitals, pharmacies, and other health care professionals that are not a part of your health plan’s provider network or pharmacy network.
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Out-of-Network Pharmacy
A pharmacy that is not a part of your health plan’s pharmacy network, so your drugs won't be covered if you get them there.
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Out-of-Network Provider
A provider that is not a part of your health plan’s provider network.
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Out-of-Pocket Costs
Costs you must cover, like deductibles, coinsurance, copayments, and any costs above the amount we allow.
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Out-of-Pocket Drug Costs
What you pay for prescription drugs.
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Out-of-Pocket Maximum
The maximum amount you'll pay towards all medical and prescription drug expenses each year. Once the maximum is reached, the health plan pays all additional costs for health care services and prescriptions received during the remainder of the plan year.
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Outpatient Care
Medical care or treatment that doesn’t include staying overnight in a hospital.
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PA
Physician's Assistant
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Palliative Care
Care, also called comfort care, that's given to relieve pain, not cure, like hospice.
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PALS
Pediatric Advanced Life Support
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PAN/PAL
Patient Advisory Nurse, Physician Access Line
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Part A
Helps cover hospital costs like room and board, other inpatient care provided in a hospital or skilled nursing facility, hospice care, and some home health care. Most people don’t have to pay a premium for Part A because they already paid for it through taxes. Part A is included in Original Medicare.
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Part B
Helps cover medical costs like doctor visits, other outpatient care, and some other medical services Part A doesn’t cover, like physical therapy. With Original Medicare, you can buy Part B for a monthly premium.
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Part C
Medicare Advantage plans that are sold by private companies with a Medicare contract that include coverage for both Part A and Part B, and sometimes Part D.
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Part D
An optional program sold by private companies with a Medicare contract to help cover your prescription drug costs. You can get Part D by buying stand-alone prescription drug plans or Medicare Advantage plans that include Rx coverage.
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Participating Provider
Providers that have agreed to provide services to our members.
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Patient Relations/Action Line
For patient's feedback on care received at Carle: 383-3333
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PBB
Provider Based Billing
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PCP
Primary Care Physician - the main doctor that a patient sees for regular visits and check-ups. For children this is generally a Pediatrician; for adults this is often someone in the Family Practice or Adult Medicine areas. Medicaid (IPA, HFS) often requires referrals from one's PCP in order to cover care provided by specialists or outside providers. Many prescriptions also require the consent of a patient's PCP.
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Pharmacy Directory
A list of the pharmacies you can use to fill your prescriptions.
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Pharmacy Network
Pharmacies that have agreed to provide prescription drugs to our members.
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PHI
Protected Health Information
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POCT
Point of Care Testing
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POS (Point of Service)
A plan with personal care and the freedom to go out-of-network. You’ll need to choose a personal doctor, called a Primary Care Physician (PCP), to manage your care and refer you to specialists.
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PR
Public Relations
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Preauthorization Penalty
A charge you get if your doctor doesn’t get preauthorization for certain drugs or services before you get them.
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Preferred Provider Option (PPO)
A plan with the freedom to go out-of-network, but you will pay less if you go to in-network doctors and hospitals.
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Pre-Op
Pre-Operation
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Preventive Services
Services like tests, screenings, and vaccines that help keep you healthy or prevent getting sick, like flu shots, mammograms, and Pap tests.
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Primary Care Provider (PCP)
A personal doctor you choose to manage your care and refer you to specialists.
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Provider Directory
The list of all the in-network doctors and hospitals you can use.
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PSC
Patient Safety Committee
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Public Exchange
The Affordable Care Act (ACA) says each state must have a Public Exchange, or a marketplace, to buy insurance.
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Quality Improvement (QI) Program
A program that sets aside time and resources to improve care and services for our members.
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Quantity Limits
Policy that limits the amount of certain drugs you’re given based on the drug maker’s package size and what the Food and Drug Administration (FDA) recommends.
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Quantros
Event Reporting system
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RC
Respiratory Care
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RelayHealth
Vendor Carle utilizes via McKesson to actually print statements.
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Renewal
When a member or group signs up to continue their insurance plan for another benefit period, sometimes with changed terms, like new rates.
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Rider
A document that's separate from the main policy that changes a benefit or adds a new one.
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RIS
Radiology Information System
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Rounding
Managers talk to staff and write reports based on findings to improve Carle.
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RX Express
Pharmacy previously operated by Carle-Now closed.
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Safety Training
Required Compliance and Saftey Lessons training that must be completed yearly. Located in the CarleLMS system.
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Self-Funded Plan
A type of plan where the employer takes on the risk and the costs of their employees’ health care to save money.
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Service Area
The location you must live in to enroll in certain plans.
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Short-Term Disability Insurance
Insurance that pays part of your wages when you're out of work because of an illness or injury that's not related to work.
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Short-Term Plans
Plans that help you with medical costs if you change jobs, missed enrollment, or are waiting until you can begin other coverage. They're not recognized by the government, so you'll still be charged a fee for not having insurance.
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SICU
Surgical Intensive Care Unit
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Skilled Care
Medical care ordered by a doctor and given or supervised by a licensed health care professional.
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Skilled Nursing Care
"Medical care ordered by a doctor that must be given or supervised by a licensed health care professional in a skilled nursing facility. Skilled nursing care includes: Doctor services and regular nursing services, X-rays and other radiology services, Lab tests, Physical, occupational, and speech therapy, Storage and administration of blood, Use of appliances, like wheelchairs, A semiprivate room or private room if medically necessary, Meals, including special diets, Meds prescribed to you as part of your treatment plan"
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Skilled Nursing Facility
A nursing home, hospital, or part of a facility that provides residents with medical care ordered by a doctor, rehab services, or both.
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Small Business Health Options Program (SHOP) Marketplace
Businesses with 50 or fewer full-time employees can use this marketplace to offer coverage to their employees.
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SME
Subject Matter Expert
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South Clinic Elevators
Located on the south side of University Avenue
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SPD
Sterile Processing and Distribution
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Special Enrollment Period (SEP)
Special cases when you can enroll or make changes in your plan outside of the Open Enrollment Period (OEP) or Annual Enrollment Period (AEP), like changing jobs, moving, getting married, or having a baby.
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Specialist
A doctor who provides health care services for a specific disease or part of the body, like dermatologists, who focus on skin care.
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Specialty Drug
Drugs that help members deal with complex diseases like cancer, rheumatoid arthritis, and multiple sclerosis. Doctors must request preauthorization for most of them and closely watch how they're used, stored, and given, (like orally, injected, or by IV,) either at a health care facility or at home.
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Stand-Alone Prescription Drug Plan
An optional program sold by private companies with a Medicare contract to help cover your prescription drug costs.
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Step-Therapy
A requirement where you must try the cheapest version of certain drugs first to make sure you try safer or more effective drugs before we will cover another drug. If a doctor thinks it’s medically necessary to skip the prerequisite, they can request a preauthorization
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Stop-Loss
Coverage a self-funded group can buy to protect themselves from losses due to catastrophic claims. If health care costs go over the amount in the contract, we pay the rest.
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Student Volunteers
Volunteers wearing business casual and serving in in-patient and out-patient settings.
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Subscriber
The person whose name is on an individual policy, (the policy owner or holder,) or employees on group policies.
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Summary of Benefits and Coverage (SBC)
A summary of what a plan covers and what it costs. This document answers common insurance cost questions and explains a plan's coverage for some common medical events.
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Summary of Benefits (SOB)
A summary of services a plan covers and what you pay for each service. For Medicare plans, it also compares what you pay for services with Original Medicare to what you pay for services with a Medicare Advantage plan.
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SurgiCenter
Outpatient surgery treatment facility. Locations are in Champaign and Danville.
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TAVR
Transcatheter Aortic Valve Replacement
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TCF
The Carle Foundation
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Termination Date
The date your plan ends.
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The dashboard
Monthly update in patient satisfaction scores and other data (part of Carle Experience)
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Tier (Pharmacy Tier)
Every drug listed in our formularies is put into one of these cost groups. For the lowest tier, you pay the lowest copayment. As you take a step up to the next tier, what you pay increases.
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TJC
The Joint Commissions (previously known as JCAHO)
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TLTL
The Lamp, The Light - quarterly journal for ambulatory snd inpatient nurses
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Tower Elevators
Located the very farthest north that give access to both Carle Tower and the North Tower.
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TPO
Treatment, Patient, or Healthcare Operations
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Transitional Plans
An old plan you can keep through 2016 without paying a fine. After that, you will have to choose a plan that meets the Affordable Care Act (ACA) regulations.
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Urgent Care
A non-emergency situation where your health is not in serious danger, but because of an illness or injury you need medical care to keep it from getting worse, like constant fever, bronchitis, sprains, and unresponsive migraine headaches.
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Utilization Management
Managing the use of medical services to make sure you get affordable, necessary, high-quality care through step-therapy, preauthorization, and managed dose limitations.
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Vimeo
Video-sharing website used to upload and share Carle related videos
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Waiting Period
The stretch of time, also known as a probationary period, an employer can make a new employee wait before getting coverage.
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Way to Be
Peer-to-peer, or employee-to-leader recognition platform based on the Carle Behavior Standards.
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Web Babies
Application for looking up baby photos
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WHCRA (Women's Health and Cancer Rights Act)
A law requiring plans to cover reconstructive surgery following a mastectomy.
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Worker's Compensation (Workmen’s Comp)
This law makes sure your medical costs are covered and that you get disability pay after you’ve been hurt at work.
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WQ
Workque(s)