- 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.
The process of dividing the total market for a product or service into smaller, more manageable subsets or groups of customers.
Industry:Health care
The provision that only those drugs on a preferred list will be covered by a PBM or MCO.6
Industry:Health care
A method used by MCOs of determining provider reimbursement that assigns a weighted value to each medical procedure or service. To determine the amount the MCO will pay to the physician, the weighted value is multiplied by a money multiplier. Also known as relative value of services.
Industry:Health care
The process of planning and executing the conception, pricing, promotion, and distribution of ideas, goods, and services to create exchanges that satisfy individual and organisational objectives.
Industry:Health care
According to the National Association of Insurance Commissioners' Quality Assessment and Improvement Model Act, managed care plans that require covered persons to use participating providers.
Industry:Health care
The process by which an underwriter reviews each year all the selection factors that were considered when the contract was issued, then compares the group's actual utilisation rates to those the MCO predicted to determine the group's renewal rate.
Industry:Health care
The manager who oversees an organization's marketing and sales activities, including advertising, client relations, and enrollment and sales forecasting. Also known as a chief marketing officer.
Industry:Health care
Documentation errors in which a treatment is miscoded or the codes used to describe procedures do not match those used to identify the diagnosis.
Industry:Health care
Estimates of money that an insurer needs to pay future business obligations.
Industry:Health care
The four major marketing elements-product, price, promotion, and distribution (place)-that foster the exchange process.
Industry:Health care
