Glossary

M

Magnetic Resonance Angiography (MRA) — 

MRA uses a powerful magnetic field, radio waves and a computer to evaluate blood vessels and help identify abnormalities or diagnose atherosclerotic (plaque) disease. This exam does not use ionizing radiation and may require an injection of a contrast material called gadolinium, which is less likely to cause an allergic reaction than iodinated contrast material.

Magnetic Resonance Imaging (MRI) — 

MRI uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the body's internal structures that are clearer, more detailed and more likely in some instances to identify and accurately characterize disease than other imaging methods.

Mammography — 

The process of using low-energy X-rays to examine the human breast for diagnosis and screening.

Managed Care — 

A variety of techniques (e.g., financial arrangements with health care providers) intended to reduce the cost of providing health benefits and improve the overall quality of care.

Maternal and Fetal Medicine — 

Maternal and fetal medicine is a branch of medicine that focuses on managing health concerns of the mother and fetus prior to, during, and shortly after pregnancy. Maternal and fetal medicine specialists are specialists within the field of obstetrics.

Maternity Management — 

Health care professional that coordinates education with risk management and case management to reduce incidence of pre-term birth weight, and help expectant mothers with high-risk pregnancies.

Medical Emergency — 

As defined in Horizon BCBSNJ’s contracts, a medical condition manifesting itself by acute symptoms of sufficient severity including, but not limited to, severe pain, psychiatric disturbances and/or symptoms of substance abuse, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:
  • Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
  • Serious impairment to bodily functions; or
  • Serious dysfunction of a bodily organ or part.

With respect to a pregnant woman who is having contractions, an emergency exists where there is not adequate time to safely transfer to another hospital before delivery, or where the transfer may pose a threat to the health or safety of the woman or the unborn child.

Medical Emergency Screening Examination — 

An examination and evaluation that is within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, and is performed by qualified personnel.

Medical Specialty — 

The type of medicine the professional practices.

Medical Transportation Provider — 

Provider of non-emergency transportation for patients to a medical facility or office who require assistance.

Medically Necessary and Appropriate — 

As defined in Horizon BCBSNJ contracts, this means or describes a health care service that a health care provider, exercising his/her prudent clinical judgment, would provide to a covered person for the purpose of evaluating, diagnosing or treating an illness, injury, disease or its symptoms and that is: in accordance with the generally accepted standards of medical practice; clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the covered person's illness, injury or disease; not primarily for the convenience of the covered person or the health care provider; and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that covered person's illness, injury or disease.

Member — 

A person who meets all rules to take part in a health and welfare benefit plan offered through a labor union or other qualified organization.

Mental Health Provider Inpatient — 

Provider of non-emergency transportation for patients to a medical facility or office who require assistance. Horizon BCBSNJ will recognize such a place if: (1) it carries out its stated purpose under all relevant state and local laws; and (2) it is:
  • a) accredited for its stated purpose by the Joint Commission;
  • b) approved for its stated purpose by Medicare; or
  • c) accredited or licensed by the state in which it is located to provide mental health services.

Mental Health Provider Outpatient — 

An outpatient facility that provides psychiatric treatment which may include medical management and monitoring to individuals experiencing episodes of mental illness. Horizon BCBSNJ will recognize such a place if: (1) it carries out its stated purpose under all relevant state and local laws; and (2) it is:
  • a) accredited for its stated purpose by the Joint Commission;
  • b) approved for its stated purpose by Medicare; or
  • c) accredited or licensed by the state in which it is located to provide mental health services.

Midwifery — 

A specialty focusing on the care of women and the fetus during pregnancy and delivery.

Mobile Diagnostics — 

Providers that provide portable diagnostic services for procedures such as radiology and cardiac monitoring.

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