- 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.
An unstructured, informal session in which six to ten people are led by a moderator who asks questions to guide the group into an in-depth discussion of a given topic.
Industry:Health care
A process that involves predicting an MCO's incoming and outgoing cash flows-primarily revenues and expenses-and predicting the values of its assets, liabilities, and capital or capital and surplus.
Industry:Health care
A listing of drugs, classified by therapeutic category or disease class, that are considered preferred therapy for a given managed population and that are to be used by an MCO's providers in prescribing medications.11
Industry:Health care
A health plan under which an insurer or MCO bears the financial responsibility of guaranteeing claim payments and paying for all incurred covered benefits and administration costs.
Industry:Health care
A patient's ability to perform the activities of daily living.
Industry:Health care
In a self-funded plan, the account into which the money that an employer and employees would have paid in premiums to an insurer or MCO is deposited until the money is paid out.
Industry:Health care
The dispensing of a drug that is the generic equivalent of a drug listed on a pharmacy benefit management plan's formulary. In most cases, generic substitution can be performed without physician approval.12
Industry:Health care
The number of primary care providers within a given radius of a particular target.
Industry:Health care
A market segment that includes groups of two or more people who enter into a group contract with an MCO under which the MCO provides healthcare coverage to the members of the group.
Industry:Health care
A legal entity that combines multiple independent physician practises under one umbrella organisation and performs certain business operations for the member practises or arranges for these operations to be performed. The GPWW may maintain its own facility for business operations or it may hire another company to provide this function. Also known as a clinic without walls.
Industry:Health care
