- 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.
Claims or benefits that occurred during a particular time period, but that have not yet been reported or submitted to an insurer or MCO, so they remain unpaid.
Industry:Health care
An out-of-plan product that an HMO offers through an agreement with an insurance company.
Industry:Health care
An appeals review that is conducted by a third party that is not affiliated with the health plan or a providers' association and has no conflict of interest or stake in the outcome of the review.
Industry:Health care
An organisation comprised of individual physicians or physicians in small group practises that contracts with MCOs on behalf of its member physicians to provide healthcare services.
Industry:Health care
A market segment composed of customers not eligible for Medicare or Medicaid who are covered under an individual contract for health coverage.
Industry:Health care
A type of stop-loss insurance that provides benefits for claims on an individual that exceed a stated amount in a given period. Also known as specific stop-loss coverage.
Industry:Health care
The combination of systems, processes, and technology that an MCO uses to provide the company's information users with the information they need to carry out their job responsibilities.
Industry:Health care
A process of identifying plan members with special healthcare needs, developing a health-care strategy that meets those needs, and coordinating and monitoring care.
Industry:Health care
The Medicare+Choice delivery option under which coverage is provided by private insurance carriers rather than through the federal government.
Industry:Health care
An interactive combination of people, computer hardware and software, communications devices, and procedures designed to provide a continuous flow of information to the people who need information to make decisions or perform activities.
Industry:Health care
