Facility Specialty Definitions

Ambulance: An entity that provides emergency and transfer transportation to a member.

 

Ambulatory Surgery Center (Endoscopy): A freestanding or a hospital-based
facility, with an organized professional staff, that provides visual examination and treatment of a body cavity by means of a scope to patients who do not require an inpatient bed. Synonyms: ASC, surgical center, Surgicenter.

 

Ambulatory Surgery Center (Eye): A freestanding or a hospital-based facility, with an organized professional staff, that provides surgical services related to eyes to patients who do not require an inpatient bed. Synonyms: ASC, surgical center, Surgicenter.

 

Ambulatory Surgery Center (General): A freestanding or hospital-based facility, with an organized professional staff, that provides surgical services to patients who do not require an inpatient bed. Synonyms: ASC, surgical center, Surgicenter.

 

Ambulatory Surgery Center (Kidney Stone): A freestanding or a hospital-based facility, with an organized professional staff, that provides surgical services for kidney stones to patients who do not require an inpatient bed. Synonyms: ASC, surgical center, Surgicenter, Lithotripsy center etc.

 

Ambulatory Surgery Center (Orthopaedic): A freestanding or a hospital-based facility, with an organized professional staff, that provides surgical services related to bones to patients who do not require an inpatient bed. Synonyms: ASC, surgical center, Surgicenter.

 

Cardiac Rehabilitation Program: Restorative services provided after certain cardiac conditions (e.g. open heart surgery, angioplasty, acute myocardial infarction) and for patients identified as being at high risk for undesirable cardiac events. It is a multidisciplinary program, which often includes counseling, education and exercise.

 

Community Mental Health Center (CMHC): A healthcare organization capable of providing comprehensive, principally ambulatory, mental health services to individuals residing or employed in a defined catchment area.

 

Diabetic Education Center: A freestanding or hospital-based facility, with an organized professional staff, that often includes counseling, education and proper management of diabetic patients.

 

Dialysis Centers – Dialysis Centers perform the process of cleansing the blood by passing it through a special machine. Dialysis is necessary when the kidneys are not able to filter the blood.

 

Durable Medical Equipment and Supplies: A device, system or equipment prescribed by a physician for a patient's use that is usable for an extended period of time.

 

Emergency Room Facility: The component of a health care organization that provides emergency care services. It is usually staffed by the physicians who specialize in emergency medicine and operates 24 hrs per day, 365 days a year.

 

Federally Qualified Health Center (FQHC)FQHC a facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general supervision of a physician.

 

Freestanding Dialysis Center: A health care facility that is separated from a hospital or other health care organization to provide dialysis to patients with renal insufficiency or failure from many causes.

 

Freestanding Sleep Centers – Sleep Centers provide clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders.

 

Freestanding Substance Abuse Facility (FSAF): A State licensed facility approved by Wellmark to provide inpatient and outpatient treatment for chemical dependency.

 

Home Health Agency: A public or private organization that provides home health care. To be certified under Medicare the agency must provide skilled nursing service and one additional therapeutic service (Physical therapy, occupational therapy, speech therapy, medical social service or home health aide) in home.

 

Home Infusion Therapy: Services directly related to the administration of drug therapy by continuous or intermittent infusion to patients or clients in their place of residence.

 

Hospice Program: Caring for the terminally ill and their families in a manner that enables the patient to live as fully as possible, makes the entire family the unit of care and centers the caring process in the home whenever appropriate.

 

Hospital-Based Mental Health Unit: A unit in a hospital for treatment of patients who require psychiatric care.

 

Hospital-based Rehab Unit – A unit within a hospital that focuses on the treatment of addictions.

 

Hospital-based Sleep Center – A unit within a hospital that provides clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders.

 

Hospital: A health care organization that has a governing body, an organized medical staff and professional staff, and inpatient facilities and provides medical , nursing, and related services of ill and injured patients twenty-four hours per day, seven days per week.

 

Laboratory: In healthcare setting can have two definitions:

  1. A place for observation, practice or testing as in cardiac catheterization labs.
  2. A facility in which materials from the human body are examined for the purpose of providing information about the state of health of human beings.

 

Magnetic Resonance Imaging (MRI) Facility, Freestanding: A health care facility that is separated from a hospital or other health care organization to provide the non-invasive diagnostic use of a nuclear magnetic resonance spectrometer. The MRI spectrometer produces electronic images of specific atoms and molecular structures in solids especially human cells, tissues and organs.

 

Mammography Center: A health care organization capable of providing diagnostic image (roentgenogram) of the breast.

 

Mental Health Institute - A health care facility providing inpatient and outpatient therapeutic services to clients with behavioral or emotional illnesses.

 

Neurophysiology:  The medical specialty that deals with the nervous system.

 

Orthotics and Prosthetics:

Orthotics: a science dealing with the use of specialized mechanical devices to support or supplement weakened or abnormal joints or limbs.
Prosthetics: A field of knowledge relating to the design and use of the prostheses, appliances used to correct extremity ailments.

Pharmacy:

  1. A branch of health science dealing with the preparation, preserving, compounding, dispensing, and proper use of drugs.
  2. A place where pharmacy is practiced.

 

Psychiatry – Geriatric:  The branch and subspecialty in psychological research, testing, and/or therapy involving patients that are elderly, or age 65 or older.

 

Public Health Agency/Visiting Nurse Association – These agencies are recognized by Wellmark to administer immunizations.  Other services billed by these locations may not be covered.    Public Health Agencies and Visiting Nurse Association locations may also provide a variety of services included home health and hospice care.

 

Psychiatric Medical Institute for Children (PMIC): A State licensed facility approved by Wellmark to provide inpatient treatment to children for behavioral health and chemical dependency.

 

Radiology Center (CT): Provides Computed Tomography imaging services as recommended or ordered by a physician.

 

Radiology Center (Mammography): Provides Mammography imaging services as recommended or ordered by a physician.

 

Radiology Centers (MRI): Provides Magnetic Resonance Imaging services as recommended or ordered by a physician.

 

Radiology Center (PET): Provides Positron Emission Tomography services as recommended or ordered by a physician.

 

Radiology Centers (Portable X-Ray): Provides Portable X-Ray services as recommended or ordered by a physician.

 

Radiology Centers (Radiation Oncology): Provides Radiation Oncology services as recommended or ordered by a physician.

 

Radiology Center (Ultrasound): Provides Ultrasound imaging services as recommended or ordered by a physician.

 

Rehabilitation Center: A health care organization specializing in rehabilitation. A facility that provides health-related, social, and/or vocational services to disabled persons to help them attain their maximum functional capacity.

 

Urgent Care Center: Urgent care is the delivery of ambulatory care in a facility dedicated to the delivery of medical care outside of a hospital emergency department on a walk-in basis without a scheduled appointment.

 
 
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Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota.
 
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