- Industry: Health care
- Number of terms: 4240
- Number of blossaries: 0
- Company Profile:
The Blue Cross Blue Shield Association (BCBSA) is a federation of 39 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans.
Claims or benefits that occurred during a particular time period, but that have not yet been reported or submitted to an insurer or MCO, so they remain unpaid.
Industry:Health care
A large single medical practice that operates in one or a few facilities rather than in many independent offices. The single-specialty or multi-specialty practice group may be formed from previously independent practices and is often owned by a parent company or a hospital. Also known as a medical group practice or clinic model.
Industry:Health care
The performance standards that an MCO sets for its member services activities.
Industry:Health care
An out-of-plan product that an HMO offers through an agreement with an insurance company.
Industry:Health care
A type of merger that occurs when previously separate providers combine to form a new organization with all the original companies being dissolved.
Industry:Health care
An MCO's success in meeting the non-clinical customer service needs and expectations of plan members.
Industry:Health care
An information system that incorporates membership data and provider reimbursement arrangements and analyzes transactions according to contract rules.
Industry:Health care
A resource for the review of surgery and certain nonsurgical interventions that indicates the most appropriate settings for common procedures.
Industry:Health care
An appeals review that is conducted by a third party that is not affiliated with the health plan or a providers' association and has no conflict of interest or stake in the outcome of the review.
Industry:Health care
