Primary care physician or local agency responsible for coordinating and managing the health care needs of members. Generally, in order for specialty services such as mental health and hospital care to be covered, the gatekeeper must first approve the referral.
A primary care provider who initially assesses a patient’s condition and needs and refers the person to the appropriate treatment or provider.
A term used to describe one role of a primary care physician in an HO or other managed care network that requires its members to have their care provided, arranged or authorized by member's primary care physicians.
a term used to describe a physician who serves as your primary contact for coordinating your medical care and referrals. This is usually a family practitioner, general internal medicine doctor, or pediatrician.
In managed care systems, a primary care provider (PCP) who is responsible for authorizing treatment by specialists or non-emergency hospitalizations. If you are in a managed care system that uses gatekeepers you must see your gatekeeper before visiting a specialist (for example, a cardiologist).
an informal though widely used term that refers to a primary care physician management model health plan. In this model, all care from providers, other than in true emergencies, must be authorized by the primary care physician before care is rendered. This is a predominant feature of most HMOs.
Most HMOs rely on the primary care physician, or "gatekeeper," to screen patients seeking medical care and effectively eliminate costly and sometimes needless referral to specialists for diagnosis and management. The gatekeeper is responsible for the administration of the patient's treatment, and this person must coordinate and authorize all medical services, laboratory studies, specialty referrals, and hospitalizations. In most HMOs, if an enrollee visits a specialist without prior authorization from his or her designated primary care physician, the medical services delivered by the specialist must be paid in full by the patient. Back to the top of the page
A term sometimes used to refer to the primary care physician in a managed care environment, because of the responsibility to oversee and coordinate the patient's overall care and the fact that the gatekeeper must authorize all referrals to specialists or other services. Without this referral, coverage may be denied by the health plan.
A primary care provider responsible for managing medical treatment to participants in managed care plans.
An entity that is responsible for coordinating and approving all health care services a patient in a health care plan seeks or receives. The gatekeeper is usually, but not always, the patient's primary care physician. The gatekeeper monitors the patient's health, ensures that the patient is using appropriate services, and directs or refers the patient to other providers, as appropriate.
The professional in an HMO who decides whether or not a patient will be referred to a specialist for further care. Physicians, nurses, and physician assistants may all function as gatekeepers.
A server that handles the addressing between the IP network and individual telephone numbers and that initializes call setups; call management system.
a part of the internet telephony installations that are based on the H
a primary care physician that directs the patient for all other services
a server in a network that manages client access to telephony services
A primary care physician responsible for overseeing and coordinating all aspects of a patient's medical care. The gatekeeper may have to preauthorize other specialty care or hospital admission.
A physician who is responsible for a patient's access to health care and who typically must approve all referrals to specialists. MANAGED HEALTH CARE A system of financial reimbursement which relies upon strategies designed to influence cost and use of treatment. NON-PARTICIPATING PROVIDER A physician or clinic that has not signed a contract with a health plan to provide treatment to the health plan's patients.
Primary Care Physician (PCP) who is responsible for overseeing and coordinating aspects of a patient's medical care that is subject to insurer rules. In order for a patient to receive a specialty care referral or hospital admission, the gatekeeper or insurer must pre-authorize the visit, unless there is an emergency in which case pre-authorization can be obtained after the fact.
A term used to describe the primary care physician’s role in a managed health care plan. In this role the physician authorizes all medical services delivered to the insured by other physicians or health care providers.
This refers to a primary care case management model health care plan. The "gatekeeper," usually a family physician, internist, or general practitioner, serves as the patient's initial contact for medical care and referrals and must see a patient before the patient can be referred to a specialist or hospital.
The primary care physician who must provide or authorize medical services for the member.
Health care professional designated to exercise responsibily for, and control of, the utilization of health care services, e.g., D.C., M.D., D.O., D.P.M., D.D.S., D.D.M.
A primary care physician who must give you a referral when you want to see a specialist or other health care provider. Some plan designs require the use of a gatekeeper. Please consult your benefit booklet.
A gatekeeper is a process used at a site to take incoming job requests and check the security to make sure each is allowed to use the associated computing resource(s). The gatekeeper process starts up the job-manager process after successful authentication.
(see also Primary Care Case Management): An individual at the entry point of treatment, such as a utilization reviewer at an MCO or a primary care provider, who is responsible for initially assessing a consumer's needs, guiding the consumer to appropriate services, and restricting access to, or reimbursement for services, judged to be not medically necessary.
An arrangement in which a primary care provider determines when a consumer may have access to specialty care, such as to a mental health clinician or service.
An arrangement in which a provider, usually a primary care physician, arranges, approves and coordinates medical care for an individual. In this system, specialty referrals are generally approved by the gatekeeper
In the context of health care, a person who determines what medical care an individual should receive. Usually this person is a primary care physician who initially evaluates a patient and provides such care determined to be necessary and within the physician's skills. If the physician determines it is necessary, he or she refers the patient for further care, for example, to a medical specialist, or admits the patient to a hospital or other health care facility.
First contact physician in a managed care setting. This physician is responsible for determining the appropriate level and delivery of care for each patient. The gatekeeper administers the patient's treatment and authorizes referrals to specialists, diagnostic tests, and hospitalizations. (See Case Management.)
A primary care physician or his/her staff who is responsible for determining when and what services a patient can access or receive reimbursement.
The role of a manager of a patients care and treatment (by specialists and institutions) usually fulfilled by a primary care physician. Because the gatekeeper is charged with screening diseases and disorders, and recommending or approving interventions as necessary, the role is designed to enhance cost effectiveness.
A primary care physician in a managed care plan (such as HMO or POS plan) who oversees the care of enrollees in the plan.
The physician selected by HMO members to serve as their personal doctor and provide all basic medical treatments and any referrals to medical specialists. Gatekeepers are prohibited in PPOs and other indemnity health plans. (Also known as a primary care physician.)
When a primary care physician, the “gatekeeper”, serves as the patient's initial contact for medical care and referrals.
In a managed care plan, like an HMO, your primary care doctor (PCP) oversees your care and decides when to refer you to specialty care.
A person or entity at the entry point of treatment who either provides all care, triages enrollees to appropriate care, and/or has the power to authorize or deny the delivery of care.
In a managed care plan, this is another name for the primary care physician (PCP). This physician gives you basic medical services and coordinates proper medical care and referrals.
The person who controls a patient's access to health care services, whether as a case manager or a primary care provider who must approve all referrals and use of health care services. This term is typically used in managed care systems.
Primary Care Provider who coordinates all care for a patient. The gatekeeper decides when a referral to a specialist is necessary or when certain tests should be done. Gatekeepers are incentivized (financially) to minimize referrals and tests.
A physician whose approval is required for a patient to seek special medical care or treatment.
A primary care physician who determines whether an insured employee needs additional medical care or should see a specialist.
A primary care physician who must give you a referral when you want to see a specialist or other health care provider. 4MOST does not use a Gatekeeper system; members are free to visit any provider they wish.
A care provider who monitors a patient's care and decides whether or not tests, specialists, hospitalization, or other treatment is needed. The gatekeeper also makes referrals if necessary. Where the gatekeeper is a physician, (s)he can also be called the "primary care physician".
In a managed health care plan, this is another name for the primary care doctor. This doctor gives basic medical services and coordinates proper medical care and must make a referral to a specialist in order for that specialist to be covered by the plan.
A primary care physician, some other individual or individuals who determine what services a patient can access. In many, but not all, cases the gatekeeper has to provide a referral for a person to be able to see a specialist. Emergency care does not typically require a person to have a referral. HMOs use the gatekeeper mechanism.
A primary care physician, some other individual or individuals who determine what services a patient can access. In most, but not all, cases the gatekeeper has to provide a referral in order for a person to be able to see a specialist. A referral is not usually required for emergency care. HMOs use the gatekeeper mechanism.
A specialist adviser who assists institutional investors in their private equity allocation decisions. Institutional investors with little experience in the asset class or those with limited resources often use gatekeepers to help manage their private equity allocation. Gatekeepers usually offer tailored services according to their clients' needs, including private equity fund sourcing and due diligence through to complete discretionary mandates. Most gatekeepers also manage funds of funds.
A term used for a primary care physician that serves as a patient's initial contact for medical care and referrals.
Decided when a patient should be referred to a specialist or when particular tests should be given.
A term used to describe the physician you select as your primary care physician. In managed care, your primary care physician is your first point of contact with the health care system. You must call or see your primary care physician before you can see a specialist or go to a hospital, unless it is an emergency.
This term can be alternately used with qualifiers. For a long-term-care policy to begin paying benefits, you must qualify for these benefits. To qualify, you must meet certain standards, gatekeepers.
Gatekeeper software uses the H.323 standard. Basically, a gatekeeper registers information about users which then enables it to look-up users and connect them. Polycom has a portable document (pdf) that describes management aspects of their gatekeeping solution. Since these are standards-based, other vendors sell similar products.
Usually refers to your primary care physician (PCP) who oversees and coordinates all aspects of your health care. In many managed care plans, your PCP must preauthorize a visit to a specialist, unless there is an emergency.
A health professional within a managed care environment who determines the patient's access to treatment. The primary care physician treats the patient and determines access to further treatment and specialists.
In health care, a primary care physician who performs initial diagnosis and refers the participant to specialist members of a provider network.
Requirements that must be met before an individual can qualify for a long-term care plan. A person must qualify for the plan's benefits before he or she can be paid out.