Glossary

USERRA is federal legislation, which applies to both ERISA and non-ERISA group health plans, that requires employers to provide certain reemployment and benefit rights to employees who take a leave of absence from work to serve in the uniformed services of the U.S.

The term "untimely submission" refers to claims for eligible medical expenses that participants submitted outside of the time frame that the plan established.  The plan denies untimely claims as ineligible expenses.

The term "UR" means utilization review.

The term "URAC" means the Utilization Review Accreditation Commission.

The term "USERRA" means the Uniformed Services Employment and Reimployment Rights Act of 1994.

The term "usual and customary" refers to the designation of a charge as being the usual charge made by a physician or other provider of services, and supplies, medications, or equipment that do not exceed the general level of charges made by other providers that render or furnish such care or treatment within the same area (e.g., a country or other area as is necessary to obtain a representative cross section of such charges).

Utilization review is a cost-control mechanism that evaluates health care on the basis of appropriateness, necessity, and quality.  It may include pre-admission certification, concurrent review during hospital confinement, discharge planning, retrospective review of confinements, and large-case management.

The URAC is a non-profit organziation that performs reviews on external utilization review agencies.

A utilization review firm is the entity that provides mandatory hospital admission certification and other utilization review services in connection with a plan.