- 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 healthcare visit of any type by an enrollee to a provider of care or services.
Industry:Health care
An evaluation of the medical necessity, appropriateness, and cost-effectiveness of healthcare services and treatment plans for a given patient.
Industry:Health care
The evaluation of health questionnaires submitted by all proposed plan members to determine the insurability of the group.
Industry:Health care
A report that supplies management information about services provided each time a patient visits a provider.
Industry:Health care
An external organization 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
Diagnostic or treatment measures for which the expected health benefits exceed the expected risks by a margin wide enough to justify the measures.15
Industry:Health care
An information system that permits physician groups, hospitals, and other facilities within an enterprise to function as a single organization 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
Services or supplies as provided by a physician or other healthcare provider to identify and treat a member's illness or injury, which, as determined by the payer, are consistent with the symptoms, diagnosis, and treatment of the member's condition; in accordance with the standards of good medical practice; not solely for the convenience of the member, member's family, physician, or other healthcare provider; and furnished in the least intensive type of medical care setting required by the member's condition.16
Industry:Health care
The length of time, on average, that members must stay on the telephone before they receive assistance.
Industry:Health care
