- 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.
Dollar amounts set by MCOs that limit the amount a member has to pay out of his/her own pocket for particular healthcare services during a particular time period.
Industry:Health care
A process the MCO uses to help determine what activities must occur before the patient is ready for discharge and the most efficient way to conduct those activities.
Industry:Health care
A contract provision, included in all standard provider contracts, that allows either the MCO or the provider to terminate the contract when the other party does not live up to its contractual obligations.
Industry:Health care
Committees that are convened to address specific management concerns. Also known as special committees.
Industry:Health care
Treatment that is provided to a patient who is able to return home after care without an overnight stay in a hospital or other inpatient facility.
Industry:Health care
A coordinated system of preventive, diagnostic, and therapeutic measures intended to provide cost-effective, quality healthcare for a patient population who have or are at risk for a specific chronic illness or medical condition. Also known as disease state management.
Industry:Health care
A contract provision that allows either the MCO or the provider to terminate the contract without providing a reason or offering an appeals process.
Industry:Health care
The extent to which a network offers the appropriate types and numbers of providers in the appropriate geographic distribution according to the needs of the plan's members.
Industry:Health care
Members of a company's board of directors who do not hold other positions with the company.
Industry:Health care
The dispensing of a different chemical entity within the same drug class of a drug listed on a pharmacy benefit management plan's formulary. Therapeutic substitution always requires physician approval.29
Industry:Health care
