- 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 MCO's success in meeting the non-clinical customer service needs and expectations of plan members.
Industry:Health care
The broad range of activities that an MCO and its employees undertake to support the delivery of the promised benefits to members and to keep members satisfied with the company.
Industry:Health care
An information system that incorporates membership data and provider reimbursement arrangements and analyses transactions according to contract rules.
Industry:Health care
A resource for the review of surgery and certain nonsurgical interventions that indicates the most appropriate settings for common procedures.
Industry:Health care
A type of structural integration that occurs when two or more separate providers are legally joined.
Industry:Health care
The Medicare+Choice delivery option that includes HMOs (with or without a point-of-service component), preferred provider organisations (PPOs), and provider-sponsored organisations (PSOs).
Industry:Health care
Although each MCO's size limit may vary, generally a group composed of 2 to 99 members for which health coverage is provided by the group sponsor.
Industry:Health care
A type of independent practise association (IPA) that simply negotiates contract terms with MCOs on behalf of member physicians, who then contract directly with MCOs using the terms negotiated by the IPA. This type of IPA is most often used with fee-for-service or discounted fee-for-service compensation arrangements.
Industry:Health care
A worldwide healthcare system operated by the U.S. Department of defence that focuses its efforts on population health improvement by integrating the delivery of healthcare services for active-duty personnel, retirees, and the families of active-duty personnel and retirees.
Industry:Health care
The MCO committee that monitors and guides all compliance activities, including appointment of a corporate compliance officer, approval of compliance programme policies and procedures, review of the organization's annual compliance plan, evaluation of internal and external audits to identify potential risks, and implementation of corrective and preventive actions.
Industry:Health care
