Provider Glossary Terms
Here you'll find definitions of basic terms used throughout this site. If you are unable to find an answer to your question, please visit our Frequently Asked Questions section, or contact us directly.
Specialist: A specialist is a doctor with extensive medical training and experience in treating a particular condition or part of the body. Examples include: surgeons, cardiologists, psychiatrists and ophthalmologists.
Urgent Care: Many situations are not emergencies, but do require immediate medical attention. These situations require what is referred to as urgent care. Examples of urgent care needs include ear infections, sprains, high fevers, vomiting and urinary tract infections. Participants should consult their Northern Illinois Health Plan network doctors for urgent care.
Referral: A referral is a request from your Primary Care Physician (PCP) for you to receive care from a specialist or other treatment such as hospital admissions, lab or x-ray services or outpatient procedures. If you participate in an Open Access plan, you do not need a referral from your PCP to see a specialist. .
Primary Care Physician (PCP): A Primary Care Physician (PCP), is your first, or primary, source of medical care - your personal doctor. The PCP you choose coordinates your medical care, including checkups, referrals to specialists, lab and x-ray services and hospital admissions. PCP-based care is an effective way to maintain better health: regular physician visits help build strong, secure doctor-patient relationships. When you enroll in the Northern Illinois Health Plan, you choose a PCP from our network of independent physicians in your service area.
Board-Certified: Any physician who has completed medical school, internship and residency in his or her chosen specialty and has successfully completed an examination conducted by a group (or board) of peers.
Participating Provider: A physician, hospital, pharmacy, laboratory or other appropriately licensed facility or provider of health care services or supplies that has entered into an agreement with a managed care entity to provide services or supplies to a patient enrolled in a health benefit plan.
Primary Care: The basic, comprehensive, routine level of health care typically provided by a person's general or family practitioner, internist or pediatrician.
Provider: A licensed health care facility, program, agency, physician or health professional that delivers health care services.
Provider Directory: Provider directories are listings of providers who have contracted with a managed care network to provide care to its participants. Participants may refer to the directory to select in-network providers. You can search the Northern Illinois Health Plan Directory on our website or by using the booklet directory provided to you.
Provider Network: A panel of providers contracted by a health plan to deliver medical services to the enrollees.