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gap fill relative value scale

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17:00 Dec 14, 2016
This question was closed without grading. Reason: Answer found elsewhere

English to Spanish translations [PRO]
Medical - Medical: Health Care / Healthcare insurance
English term or phrase: gap fill relative value scale
Hola a todos:
Estoy traduciendo un seguro médico para una empresa y dice lo siguiente:

■ When Covered Health Services are received from a non-Network provider, Eligible Expenses are determined, based on:
- Negotiated rates agreed to by the non-Network provider and either the Plan Administrator or one of the Plan Administrator's vendors, affiliates or subcontractors, at the Plan Administrator's discretion.
- If rates have not been negotiated, then one of the following amounts:
♦ For Covered Health Services other than Pharmaceutical Products, Eligible Expenses are determined based on available data resources of competitive fees in that geographic area.

♦ When Covered Health Services are Pharmaceutical Products, Eligible Expenses are determined based on 110% of the published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar service within the geographic market.

♦ When a rate is not published by CMS for the service, UnitedHealthcare uses a gap methodology established by OptumInsight and/or a third party vendor that uses a relative value scale. The relative value scale is usually based on the difficulty, time, work, risk and resources of the service. If the relative value scale currently in use becomes no longer available, UnitedHealthcare will use a comparable scale(s). UnitedHealthcare and OptumInsight are related companies through common ownership by UnitedHealth Group. Refer to UnitedHealthcare's website at www.myuhc.com for information regarding the vendor that provides the applicable gap fill relative value scale information.
Alguna sugerencia para el término gap/gap fill? Se refiere a una metodología de diferencia?

Muchas gracias!
Belén
Belen Nieto
Local time: 01:41


Summary of answers provided
4 +1Metodología de vacíos (o Metodología de cálculo de equivalentes) /Escala de valores relativos
Marta Casals
2método de la diferencia de precios/información del valor de escala relativo aplicable para
Verónica Lassa


  

Answers


3 hrs   confidence: Answerer confidence 4/5Answerer confidence 4/5 peer agreement (net): +1
gap methodology/ gap fill relative value scale
Metodología de vacíos (o Metodología de cálculo de equivalentes) /Escala de valores relativos


Explanation:
Hola Belén,
Se refiere al método utilizado para calcular un equivalente de la tarifa mediante una escala de valores relativos.

Saludos,
Marta


Marta Casals
Czech Republic
Local time: 06:41
Works in field
Native speaker of: Native in SpanishSpanish, Native in CatalanCatalan
PRO pts in category: 16

Peer comments on this answer (and responses from the answerer)
agree  Mónica Algazi
6 hrs
Login to enter a peer comment (or grade)

3 hrs   confidence: Answerer confidence 2/5Answerer confidence 2/5
gap methodology/ gap fill relative value scale
método de la diferencia de precios/información del valor de escala relativo aplicable para


Explanation:
... para definir la diferencia de precio.

Creo que puede ir por ahí.


    Reference: http://europa.eu/rapid/press-release_IP-05-1127_en.htm?local...
    Reference: http://europa.eu/rapid/press-release_IP-05-1127_es.htm?local...
Verónica Lassa
Argentina
Local time: 01:41
Native speaker of: Spanish
PRO pts in category: 12
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Changes made by editors
Dec 14, 2016 - Changes made by Patricia Ferreira Larrieux:
Term askedgap methodology/ gap fill relative value scale » gap fill relative value scale


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