- 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 external organisation that conducts reviews to assess the medical appropriateness of suggested courses of treatment for patients, thereby providing the patient and the purchaser increased assurance of the value and quality of healthcare services.
Industry:Health care
A device that answers calls with a recorded message and then routes calls to the appropriate department or unit.
Industry:Health care
The practise of underwriting a number of small groups as if they constituted one large group.
Industry:Health care
An information system that permits physician groups, hospitals, and other facilities within an enterprise to function as a single organisation in arranging access to facilities and resources.
Industry:Health care
The differences obtained from subtracting actual results from expected or budgeted results.
Industry:Health care
An ethical principle which, when applied to managed care, states that MCOs and their providers have a duty to respect the right of their members to make decisions about the course of their lives.3
Industry:Health care
A utilisation management technique that requires plan members who are scheduled for inpatient care to have preliminary tests, such as X-rays and laboratory tests, performed on an outpatient basis prior to admission.
Industry:Health care
The length of time, on average, that members must stay on the telephone before they receive assistance.
Industry:Health care
The financial statement that shows an MCO's financial status on a specified date.
Industry:Health care
A utilisation management technique that requires a plan member or the physician in charge of the member's care to notify the plan, in advance, of plans for a patient to undergo a course of care such as a hospital admission or complex diagnostic test. Also known as prior authorization.
Industry:Health care
