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| QM |
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See Quality Management (QM).
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| QM Committee |
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MCO committee responsible for oversight of the Quality Management (QM) program—including the setting of standards, review of data, feedback to Providers, follow-up, and approval of sanctions—and for the Quality of care delivered to members.
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| Qualified Medicare Beneficiary (QMB) |
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This is a person whose income is below the federal poverty guidelines. In these cases, the state is required to pay the Medicare Part B Premiums, plus any Deductibles or Copayments.
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| Qualifying Event |
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An occurrence (such as death, termination of employment, divorce, etc.) that triggers an Insured's protection under COBRA, which requires Continuation of Benefits under a Group insurance plan for former employees and their families who would otherwise lose health care Coverage.
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| Quality |
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In a Managed Care context, an MCO's success in providing healthcare and other services in such a way that plan members' needs and expectations are met.
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| Quality Assurance |
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Activities involving a review of Quality of services and the taking of any corrective actions to remove any deficiencies.
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| Quality Management (QM) |
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An organization-wide process of measur-ing and improving the Quality of the healthcare provided by an MCO.
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| Quality Program |
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An organization-wide initiative to measure and improve the service and care provided by an MCO.
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| Quantity Limits |
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For some medications, the insurer may limit the number of tablets or units that you can receive per month. These guidelines are based on maximum dosages recommended by the FDA.
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| Quarantine Benefit |
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A Benefit paid for loss of time resulting from the quarantining of an Insured by health authorities.
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| Quarantine Indemnity |
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See Quarantine Benefit.
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