- 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.
Large group accounts that have employees in more than one geographic area that are covered through a single national contract for health coverage.17 Contrast with large local groups.
Industry:Health care
The review and verification process used to determine the current clinical competence of a provider and whether the provider meets the MCO's pre-established criteria for participation in the network.
Industry:Health care
Ratios that relate the number of providers in the network to the number of enrollees in the health plan.
Industry:Health care
A database maintained by the federal government that contains information on physicians and other medical practitioners against whom medical malpractice claims have been settled or other disciplinary actions have been taken.
Industry:Health care
The MCO committee that establishes and updates credentialing processes and criteria and reviews provider credentials during the credentialing and recred-entialing processes.
Industry:Health care
A type of community rating in which an MCO considers only community-wide data and establishes the same financial performance goals for all risk classes. Also known as pure community rating.
Industry:Health care
The excess of total revenues over total expenses. Also known as profit.
Industry:Health care
A measure of the statistical predictability of a group's experience.
Industry:Health care
A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.
Industry:Health care
If total expenses exceed total revenues, the excess of total expenses over total revenues.
Industry:Health care
