- 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.
Any harm a patient suffers that is caused by factors other than the patient's underlying condition.
Industry:Health care
A system in which the appropriateness of healthcare services delivered by a provider to health plan members is evaluated by a panel of medical professionals.
Industry:Health care
A review programme that evaluates whether drugs are being used safely, effectively, and appropriately.9
Industry:Health care
A pharmacy benefit co-payment system under which a member is required to pay one co-payment amount for a generic drug and a higher co-payment amount for a brand-name drug.
Industry:Health care
The MCO committee that reviews cases of healthcare services delivery in which the quality of care is questionable or problematic.
Industry:Health care
Provisions in the HMO Act of 1973 that required employers that offered healthcare coverage to more than 25 employees to offer a choice of traditional indemnity coverage or managed healthcare coverage under either a closed-panel HMO or an open-panel HMO.
Industry:Health care
An illegal business practise that occurs when an organisation conditions the sale of one product or service on the sale of other products or services.
Industry:Health care
A person who is authorised by an MCO or an insurer to act on its behalf to negotiate, sell, and service managed care contracts.
Industry:Health care
An organisation or group of practising physicians and other healthcare professionals paid by the federal government to evaluate the services provided by other practitioners and to monitor the quality of care given to Medicare patients.
Industry:Health care
Elderly and disabled Medicaid recipients who also qualify for Medicare coverage.
Industry:Health care
