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Small Business Health Options Program (SHOP)

Similar to the individual market exchanges (or marketplaces) the SHOP exchanges allow small businesses to select health plans for their employees (or contribute to employee selected health plans). As with the individual market exchanges, the SHOP exchanges can be run by the federal government or by the individual states.

Utilization Review (UR)

Refers to the evaluation of the efficiency and need of health care services, including procedures and facilities, according to established criteria of the provisions of…