- 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.
A method used by MCOs of determining provider reimbursement that attempts to take into account, when assigning a weighted value to medical procedures or services, all resources that physicians use in providing care to patients, including physical or procedural, educational, mental (cognitive), and financial resources.
Industry:Health care
The MCO committee that evaluates proposed policies and action plans related to clinical practise management, including changes in provider contracts, compensation, and changes in authorization procedures, reviews data regarding new medical technology, and examines proposed medical policies.
Industry:Health care
A person, location, or device furnished by a company to deliver information or services to customers.
Industry:Health care
A type of utilisation review that occurs after treatment is completed in order to authorise payment and medical necessity and appropriateness of care.
Industry:Health care
A rating method that sets premiums for financing medical care according to the health plan's expected costs of providing medical benefits to the community as a whole rather than to any sub-group within the community. Both low-risk and high-risk classes are factored into community rating, which spreads the expected medical care costs across the entire community.
Industry:Health care
The amounts earned from a company's sales of products and services to its customers.
Industry:Health care
The process of determining premium rates in which a managed care organisation categorises its members into classes or groups based on demographic factors, industry characteristics, or experience and charges the same premium to all members of the same class or group.
Industry:Health care
The statistical adjustment of outcomes measures to account for risk factors that are independent of the quality of care provided and beyond the control of the plan or provider, such as the patient's gender and age, the seriousness of the patient's condition, and any other illnesses the patient might have. Also known as case-mix adjustment.
Industry:Health care
The health plan physician executive who is responsible for the quality and cost-effectiveness of the medical care delivered by the plan's providers. Also known as a chief medical officer.
Industry:Health care
The MCO committee that addresses issues related to compensation of the CEO and the MCO's general compensation and benefit policies.
Industry:Health care
