- 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.
A contract provision that allows either the MCO or the provider to terminate the contract without providing a reason or offering an appeals process.
Industry:Health care
The integration of both the financing and delivery of health-care within a system that seeks to manage the accessibility, cost, and quality of that care.
Industry:Health care
The dispensing of a different chemical entity within the same drug class of a drug listed on a pharmacy benefit management plan's formulary. Therapeutic substitution always requires physician approval.29
Industry:Health care
Any entity that utilizes certain concepts or techniques to manage the accessibility, cost, and quality of health-care.
Industry:Health care
The activities and systems designed to make products or services available so that consumers can buy them.
Industry:Health care
A company that provides administrative services to MCOs or self-funded health plans but that does not have the financial responsibility for paying benefits.
Industry:Health care
Any dental plan offered by an organization that provides a benefit plan that differs from a traditional fee-for-service plan.
Industry:Health care
The length of time that members must drive to reach a primary care provider, which is typically set at a maximum of 15 minutes for urban areas and up to 30 minutes for rural areas.
Industry:Health care
A pharmacy benefit copayment system under which a member is required to pay one co-payment amount for a generic drug, a higher co-payment amount for a brand-name drug included on the health plan's formulary, and an even higher co-payment amount for a non-formulary drug.
Industry:Health care
