- 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.
Health insurance plans that are administered like traditional indemnity plans but which include managed care "overlays" such as precertification and other utilization review techniques.
Industry:Health care
The amount of time required to complete a particular member-initiated transaction.
Industry:Health care
An organization, owned by a hospital or a group of investors, that provides management and administrative support services to individual physicians or small group practices in order to relieve physicians of non-medical business functions so that they can concentrate on the clinical aspects of their practice.
Industry:Health care
A review program 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
A rating method under which a health plan uses the plan's average experience with all groups - and sometimes the experience of other health plans - rather than a particular group's experience to calculate the group's premium. An MCO often lists manual rates in an underwriting or rating manual.
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 practice that occurs when an organization conditions the sale of one product or service on the sale of other products or services.
Industry:Health care
The process of dividing the total market for a product or service into smaller, more manageable subsets or groups of customers.
Industry:Health care
