Healthcare provider means any person or entity including a hospital, physician or a network of providers that provided healthcare services and/or treatments to or on behalf of a Settlement Program Claimant.
Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.
Healthcare services means any services included in the furnishing to any individual of medical, podiatric, or dental care, or hospitalization, or incident to the furnishing of that care or hospitalization, and the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability. Medically Necessary means medical, surgical, or other services required for the prevention, diagnosis, cure, or treatment of a health-related condition, including such services necessary to prevent a decremental change in either medical or mental health status. Originating Site means a site at which a patient is located at the time Healthcare Services are provided to them by means of telemedicine, which can be include a patient's home where Medically Necessary and Clinically Appropriate. Store-and-forward Technology means the technology used to enable the transmission of a patient's medical information from an Originating Site to the Healthcare Provider at the Distant Site without the patient being present. Telemedicine means the delivery of clinical Healthcare Services by use of real time, two-way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including, but not limited to: online adaptive interviews, remote patient monitoring devices, audiovisual communications, including the application of secure video conferencing and store-and-forward technology to provide or support healthcare delivery, which facilitate the assessment, diagnosis, counseling and prescribing treatment, and care management of a patient’s health care while such patient is at an Originating Site and the Healthcare Provider is at a Distant Site, consistent with applicable federal laws and regulations. “Telemedicine” does not include an email message or facsimile transmission between a Provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions. General Requirements
COVERED HEALTHCARE SERVICES means any service, treatment, procedure, facility, equipment, drug, device, or supply that we have reviewed and determined is eligible for reimbursement under this plan.
Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.