- 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 utilisation and quality management mechanism designed to aid providers in making decisions about the most appropriate course of treatment for a specific clinical case.
Industry:Health care
A reduction in the price of a particular pharmaceutical obtained by a PBM from the pharmaceutical manufacturer.27
Industry:Health care
Health insurance plans that are administered like traditional indemnity plans but which include managed care "overlays" such as precertification and other utilisation review techniques.
Industry:Health care
The development and implementation of parameters for the delivery of health-care services to plan members.
Industry:Health care
A situation in which the state insurance commissioner, acting for a state court, takes control of and administers an HMO's assets and liabilities.
Industry:Health care
An organization, owned by a hospital or a group of investors, that provides management and administrative support services to individual physicians or small group practises in order to relieve physicians of non-medical business functions so that they can concentrate on the clinical aspects of their practice.
Industry:Health care
A type of outcomes measure that relates to biological health outcomes.
Industry:Health care
An MCO's periodic review of the qualifications of a current network provider to verify that the provider still meets the standards for participation in the network.
Industry:Health care
A rating method under which a health plan uses the plan's average experience with all groups - and sometimes the experience of other health plans - rather than a particular group's experience to calculate the group's premium. An MCO often lists manual rates in an underwriting or rating manual.
Industry:Health care
A provision which specifies that plan members must obtain medical services only from network providers through a primary care physician to receive benefits.
Industry:Health care
