Prior authorization glossary
UM Operations
- Adverse Determination
- Appeal
- Carve-Out
- Certification Number
- Clinical Criteria
- Concurrent Review
- Expedited Request
- Gold Carding
- Level of Care
- Medical Necessity
- Peer-to-Peer Review
- Pend
- Precertification
- Prior Authorization
- Retrospective Review
- Standard Request
- Straight-Through Processing (Auto-Approval)
- Turnaround Time (TAT)
- UM Delegation
- Utilization Management (UM)
- Utilization Management Organization (UMO)
Standards & EDI
- 270/271 (Eligibility Inquiry and Response)
- 837 (Health Care Claim)
- 999 (Implementation Acknowledgment)
- AAA Segment
- CAQH CORE
- Clearinghouse
- Companion Guide
- Covered Entity
- HCR Action Code
- HIPAA Transaction Standards
- Operating Rules
- Rejection Reason (Reject Reason Code)
- Service Type Code
- TA1 (Interchange Acknowledgment)
- TR3 / Implementation Guide
- Trading Partner
- UM01 Request Category Code
- UM02 Certification Type Code
- X12 275
- X12 278