- 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.
Managing the use of medical services to ensure that a patient receives necessary, appropriate, high-quality care in a cost-effective manner.
Industry:Health care
The method that an employer or other payer or purchaser uses to pay medical benefit costs and administrative expenses.
Industry:Health care
The MCO committee that reviews and updates the MCO's utilisation management program, establishes utilisation review protocols, reviews referral and utilisation patterns, and reviews utilisation decisions for medical appropriateness.
Industry:Health care
Term used to describe a provider organisation that bears the insurance risk associated with the healthcare it provides.
Industry:Health care
A healthcare visit of any type by an enrollee to a provider of care or services.
Industry:Health care
An evaluation of the medical necessity, appropriateness, and cost-effectiveness of healthcare services and treatment plans for a given patient.
Industry:Health care
A health plan's system of approving payment of benefits for services that satisfy the plan's requirements for coverage.
Industry:Health care
A healthcare option that allows members to choose at the time medical services are needed whether they will go to a provider within the plan's network or seek medical care outside the network.
Industry:Health care
A report that supplies management information about services provided each time a patient visits a provider.
Industry:Health care
