- 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 document that provides background information about various underwriting impairments and suggests the appropriate action to take if such impairments exist.
Industry:Health care
The MCO committee that evaluates proposed policies and action plans related to clinical practice management, including changes in provider contracts, compensation, and changes in authorization procedures, reviews data regarding new medical technology, and examines proposed medical policies.
Industry:Health care
Criteria that, if unmet, will cause an automated claims processing system to "kick out" a claim for further investigation.
Industry:Health care
Requirements, sometimes relating to group characteristics or financing measures, that MCOs at times impose in order to provide healthcare coverage to a given group and which are designed to balance a health plan's knowledge of a proposed group with the ability of the group to voluntarily select against the plan (antiselection).
Industry:Health care
The use of computer networks to perform business transactions and to facilitate the delivery of healthcare and non-clinical services to an MCO's members.
Industry:Health care
A coding inconsistency that involves using a code for a procedure or diagnosis that is more complex than the actual procedure or diagnosis and that results in higher reimbursement to the provider.
Industry:Health care
The computer-to-computer transfer of data between organizations using a data format agreed upon by the sending and receiving parties.
Industry:Health care
The amount commonly charged for a particular medical service by physicians within a particular geographic region. UCR fees are used by traditional health insurance companies as the basis for physician reimbursement.
Industry:Health care
