Glossary
Short version: definitions of the review types, program terms and software terms used across this site, written for a physician who knows the medicine and not the vendor jargon.
Limits: We scored every product from its own public pages on 2026-11-12 and did not run files through any of them, ours included. Prices and terms change; check the linked source before you buy.
Review types
- IME (independent medical examination)
- An exam and record review by a physician who does not treat the patient, requested by an insurer, employer or attorney to answer questions such as causation, work status or maximum medical improvement.
- QME (qualified medical evaluator)
- A physician certified by the California Division of Workers' Compensation to write medical-legal reports in disputed workers' comp claims.
- AME (agreed medical evaluator)
- A physician both sides in a California workers' comp case agree on, instead of each using a QME.
- Peer review
- Review of a physician's care by other physicians. In a hospital it runs through the medical staff under its bylaws; payers and review companies also buy external peer reviews of a claim or an appeal.
- OPPE (ongoing professional practice evaluation)
- Continuous monitoring of each privileged practitioner's performance, required by The Joint Commission's medical staff standards.
- FPPE (focused professional practice evaluation)
- A time-limited review of a practitioner, used for new privileges or when a performance concern comes up.
- Utilization review (UR)
- Review of whether care, a stay or a level of care is medically necessary, done by hospitals and health plans against a criteria set or policy.
- Concurrent review
- Utilization review while the patient is still in care, as opposed to retrospective review after discharge.
- Physician advisor
- A hospital physician who handles second-level utilization review, talks to payer medical directors and supports appeals.
- Second-level review
- Physician review of a case the UR nurse could not approve against criteria at first level.
- Peer-to-peer
- A call between the treating or advising physician and the payer's physician reviewer to discuss a denial or a pending decision.
- InterQual
- Optum's set of medical necessity criteria, used by hospitals and health plans in utilization review.
- IRO
- An outside organization that reviews a health plan's denial on appeal, under federal and state external review rules.
- Expert review
- A physician's review of the record for litigation, usually on whether care met the standard of care or what caused an injury.
- Standard of care
- What a reasonable physician in the same specialty would have done in the same situation. Experts test the record against it date by date.
Software and contract terms
- Chronology
- A date-ordered list of the events in a record file, 1 entry per encounter or event.
- Page citation
- The page number in the file that a summary line or answer came from, ideally a link that opens that page.
- Deduplication
- Finding and setting aside pages that repeat, such as the same note produced by 2 providers. Some tools bill only unique pages.
- OCR
- Optical character recognition: turning scanned pages and handwriting into text a tool can search.
- BAA (business associate agreement)
- The HIPAA contract a vendor signs before it handles protected health information for you. Check that it names the product you use.
- PHI (protected health information)
- Health information that identifies a person, covered by HIPAA when held by a covered entity or its business associate.
- SOC 2
- An audit report on a vendor's security controls by an outside accounting firm. Type II covers how the controls worked over a period.
- Credits
- Prepaid units, often 1 per page, that some tools sell in packs. Check whether they expire.
- Rubric
- This site's 12-point scoring method: 6 tests, 0 to 2 points each. See the methodology.