National Provider Identifier (NPI)
The NPI is a 10-digit number used to identify providers in standard electronic transactions. It is a requirement of the Health Insurance Portability and Accountability Act of 1996.
A procedure or service that is essential for maintaining your health is designated as necessary treatment.
A network is a group of healthcare providers who have agreed to charge a set rate for members of a health benefits plan. Providers on the list of network members are also called participating providers. Your network choices may vary, depending on your plan and where you live.
Network (and in-network provider)
Humana has negotiated lower rates from specific doctors, hospitals, and other providers, so these providers are part of Humana's networks and are referred to as in-network providers. They are also called participating providers.
Financial agreement applied to a specific dentist or dental network.
Also known as in-network providers, these include hospitals, healthcare treatment facilities, healthcare practitioners, and other providers who enter into an agreement with an insurer and are, therefore, designated to provide services to anyone covered by that insurance provider.More than 350,000 doctors are members of Humana's network and provide discounts to Humana health plan members.
Non-Availability Statement (NAS)
A certification by a commander (or a designee) of a uniformed services MTF, recorded in DEERS, generally for the reason that the needed medical care being requested by a non-TRICARE Prime enrolled beneficiary cannot be provided at the facility concerned because the necessary resources are not available in the time frame needed.
Employee benefit plans paid for by the employer, non contributory plans require that 100% of eligible employees participate.
Non-duplication of benefits
This stipulation in a contract relieves a third-party payer of liability for cost of services in cases where services are covered under another program. Non-duplication of Benefits is distinct from Coordination of Benefits because
Non-formulary drugs are those not included on a plan-approved list.
Non-network (Medicare Advantage plans)
This refers to doctors, hospitals, pharmacies, and other healthcare professionals or suppliers who do not belong to a health plan's provider network. See the definition of network.
Non-participating pharmacy (Medicare Advantage plans and Medicare prescription drug plans)
See definition for out-of-network pharmacy.
Non-participating physician (Medicare advantage plans)
See definition for out-of-network doctor.
Any provider who is not a part of the network of a benefit plan is considered a non-participating provider.
Non-preferred brand drug
Higher-cost brands that include drugs with preferred generic or therapeutic alternatives are referred to a non-preferred brand drugs. This may includes some self-administered injectable medications.
This is a network pharmacy that offers covered Part D drugs at negotiated prices but at higher cost-sharing levels than a preferred pharmacy.
For a spending account, this is the amount that is not reimbursable from your account based on plan or IRS rules.
For a spending account, this is an expense that is not reimbursable from your account based on plan or IRS rules.
A nursing facility primarily provides skilled nursing care and related services to residents. Services may include rehabilitation for people who are injured, disabled, or sick. Nursing facilities may also provide regular health-related care services above the level of custodial care. These facilities do not usually include services for those with mental disabilities.
These homes provide residents with a room, meals, and help with activities related to daily living and recreation. Generally, nursing home residents have physical or mental problems that keep them from living on their own. They usually require daily assistance.