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Date of Service: Refers to the date that healthcare services were delivered to the insured individual.
Days: Refers to the number of days that an insurance plan will reimburse inpatient care and treatment services.
Days / 1000: Refers to the number of inpatient days for every 1,000 insurance plan members. The formula is: number of days x 1,000 members x number of months.
Deductible: A deductible is the expense an insured person has to pay out of their own pocket before their insurance plan will pay for eligible coverage benefits.
Deductible Carry-Over Credit: Refers to charges applied to the deductible for medical services associated with the last three months of the calendar year in order to satisfy the plan's annual deductible. The deductible of the prior year may or may not have been met.
Deferred Compensation Administrator (DCA): The deferred compensation administrator provides services through retirement planning administrative duties, self-insured plans, compensation planning, third-party administrative functions, and workers' compensation claims.
Delete: HCFA uses this term when removing an individual from an insurance plan's Medicare product.
Delivery System: Scroll to Organized Delivery Systems
Demand Management: Provides patients with information about their conditions or symptoms in order to help them make informed decisions regarding their treatment options.
Dental Care Plans: Provides service and coverage for dental care and related dental services.
Department of Labor (DOL): The federal executive government department that administers and enforces statutes that promote the welfare of United States wage earners. The agency's mission is to improve working conditions for American workers and advance profitable employment opportunities.
Dependent: Someone who obtains their health insurance coverage through a parent, spouse, or grandparent who is the main insurance plan enrollee.
Dependent Care Flexible Spending Account: This type of spending account is designed to offer tax-exempt funds to workers for childcare or other dependent expenses. Dependent care FSA funds are usually exempt from a federal income tax and most state taxes, which can result in significant cost savings.
Designated Mental Health Provider: A contracted health plan provider who evaluates, diagnoses, and provides mental healthcare services or substance abuse services. This provider may also provide referrals should patients require other medical services from different types of providers.
Detoxification: The medically supported process by which an addicted person is weaned from a substance of addiction.
Diagnosis: Refers to the clinical identification of a medical condition or disease.
Diagnosis Related Groups (DRGs): Refers to the classification system or inpatient hospital care based on an initial diagnosis, secondary diagnosis, age, gender, surgical history, and presence of health complications. This system is used to approximate fees required to reimburse the facility and its providers for medical services rendered.
Diagnostic and Statistical Manual, 4th Edition: Published by the American Psychiatric Association, this manual describes diagnostic criteria and terminology associated with the practice of psychiatry. It is regarded as the standard among mental healthcare professionals and researchers.
Disability: Any type of condition that limits functionality, which interferes with a person's ability to perform their work. A disability also limits one or more life activities.
Disability Management: A strategy for preventing disability. In the case of a disabling injury or sickness, disability management provides a basis for returning to work in a safe and timely manner as well as to promote functional capabilities.
Disallowance: Occurs when the payer denies certain portions of a claim amount.
Discharge Planning: Refers to patient evaluation concerning care and medical needs once discharged from the inpatient setting.
Disease: An interruption of physical and mental functionality.
Disease Classification: Refers to the systematic grouping of diagnoses into a limited number of homogeneous categories.
Disease Episode: The duration of time that an individual has a disease. Disease Management: Refers to the interventions need to prevent the worsening of a disease.
Disease State: A clinical condition that is associated with a group of symptoms, clinically identified signs, and associated laboratory assessments.
Disenrollment: Occurs when a carrier terminates an individual or group's coverage.
Domestic Partners: Refers to a committed relationship between two people who are not relatives.
Drug Formulary: Refers to a prescription drug list that is favored by an insurance plan. Listed drugs are dispensed by participating pharmacies to the insured individuals. Formularies are subject to both review and modification by clinical professionals working with the insurer. Sometimes the drug formulary will be referred to as the preferred drug list.
Drug Maintenance List: See Additional Drug Benefit List.
Drug Price Review (DPR): The DPR is updated on a weekly basis and refers to drug prices.
Drug Use Evaluation (DUE): Refers to the evaluation of prescription drug usage, patterns of prescribing among doctors, and drug utilization among patients.
Drug Utilization Review (DUR): Refers to the evaluation of prescription medication use, patters of prescribing by clinicians, and utilization of drug therapy by patients.
Dual Choice (DC): A situation where just two insurance carriers are contracted by a single group.
Dual Diagnosis: Refers to the instance when a patient suffers from two or more co-existing disorders. The term is most frequently used to describe someone who has been diagnosed with a mental disorder and substance addition.
Dual Eligible: Refers to an individual covered by both Medicare and Medicaid.
Duplicate Coverage Inquiry (DCI): Occurs when an insurance company requests another insurer or group plan to determine if coverage exists so that benefits may be coordinated.
Duplication of Benefits: Occurs when benefits overlap or when an individual has identical coverage under more than one health insurance plan. This frequently occurs when a person has their own coverage as an enrollee and is also covered by their spouse's plan.
Durable Medical Equipment (DME): Refers to medical equipment designed for continuous or repeated use. In other words, it is not disposable. Examples of a DME include wheelchairs and hospital beds.