- 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 technology that unites a computer system with a telephone system so that the two technologies function seamlessly.
Industry:Health care
A health plan under which an employer or other group sponsor, rather than an MCO or insurance company, is financially responsible for paying plan expenses, including claims made by group plan members. Also known as a self-insured plan.
Industry:Health care
Diagnostic or treatment measures for which the expected health benefits exceed the expected risks by a margin wide enough to justify the measures.15
Industry:Health care
Services or supplies as provided by a physician or other healthcare provider to identify and treat a member's illness or injury, which, as determined by the payer, are consistent with the symptoms, diagnosis, and treatment of the member's condition; in accordance with the standards of good medical practice; not solely for the convenience of the member, member's family, physician, or other healthcare provider; and furnished in the least intensive type of medical care setting required by the member's condition.16
Industry:Health care
A type of utilisation review that occurs while treatment is in progress and typically applies to services that continue over a period of time.
Industry:Health care
A market segment that is comprised largely of persons over age 65 who are eligible for Medicare benefits.
Industry:Health care
Individuals who meet the financial resource requirements of categorically needy individuals, but whose monthly income exceeds specified maximums.
Industry:Health care
A large single medical practise that operates in one or a few facilities rather than in many independent offices. The single-specialty or multi-specialty practise group may be formed from previously independent practises and is often owned by a parent company or a hospital. Also known as a medical group practise or clinic model.
Industry:Health care
The performance standards that an MCO sets for its member services activities.
Industry:Health care
A type of merger that occurs when previously separate providers combine to form a new organisation with all the original companies being dissolved.
Industry:Health care
