- 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.
The process of receiving, reviewing, adjudicating, and processing claims.
Industry:Health care
In a managed care context, an MCO's success in providing health-care and other services in such a way that plan members' needs and expectations are met.
Industry:Health care
A utilisation review resource that establishes an average inpatient length of stay based on a patient's diagnosis, the severity of the patient's condition, and the type of services and procedures prescribed for the patient's care.
Industry:Health care
A Health Care Financing Administration programme designed to strengthen MCOs' efforts to protect and improve the health and satisfaction of Medicare and Medicaid enrollees.26
Industry:Health care
Employees in the claims administration department who consider all the information pertinent to a claim and make decisions about the MCO's payment of the claim. Also known as claims analysts.
Industry:Health care
An organization-wide process of measuring and improving the quality of the healthcare provided by an MCO.
Industry:Health care
The number and timing of losses that will occur in a given group of insureds while the coverage is in force.
Industry:Health care
The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim.
Industry:Health care
The MCO committee that oversees the organization's quality assessment and improvement activities in both clinical and non-clinical areas.
Industry:Health care
