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Prior Authorization

A process where a healthcare provider must get approval from a health insurance plan before a patient can receive certain medical services or prescriptions. Without approval, the service may not be covered.

Traditional Medicare

Refers to the original Medicare program, managed directly by the federal government, consisting of Part A (hospital insurance) and Part B (medical insurance). This is distinct from Medicare Advantage plans offered by private companies.

Secretary of Health and Human Services (HHS)

The head of the U.S. Department of Health and Human Services, responsible for federal health programs, including Medicare.

Center for Medicare and Medicaid Innovation (CMMI)

A part of the Centers for Medicare & Medicaid Services (CMS) that develops and tests new healthcare payment and service delivery models to improve care and reduce costs.

Social Security Act

The foundational federal law that established the Social Security program, including Medicare. Title XI of this act deals with general provisions, including CMMI's authority.

Artificial Intelligence (AI)

Computer systems or programs designed to perform tasks that typically require human intelligence, such as learning, problem-solving, and decision-making. In healthcare, it might be used to process claims or make coverage recommendations.