- 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 utilization review resource that recognizes generally accepted community standards of practice and the overall experience and expert opinion of medical directors and other healthcare providers.
Industry:Health care
Ensures that people receive full benefits and prevents double payment for services when a member has coverage from two or more sources. The language gives the order for what insurance organization has primary responsibility for payment and what insurance organization has secondary responsibility for payment.
Industry:Health care
The excess of total revenues over total expenses. Also known as profit.
Industry:Health care
A knowledge-based computer system whose purpose is to provide expert consultation to information users for solving specialized and complex problems.10
Industry:Health care
If total expenses exceed total revenues, the excess of total expenses over total revenues.
Industry:Health care
Performance standards that are based on outside information such as published industry-wide averages or best practices.
Industry:Health care
The group of physicians, hospitals, and other medical care professionals that a managed care plan has contracted with to deliver medical services to its members.
Industry:Health care
A private computer network that incorporates Web-based technologies and links selected resources of an MCO to external entities or individuals.
Industry:Health care
An individual or organization that offers care directly to the member. The direct care provider is in the same physical location as the member and offers care to patients from within the local Plan's service area. Some examples are: (1) a provider who physically examines the patient, (2) a lab that performs the blood draw from a patient, or (3) a technician who fits a prosthetic limb to the patient. The direct care provider should file claims to the local Blue Plan. BlueCard applies if the provider of service is outside the member's Plan's service area and does not contract with the member's Blue Plan.
Industry:Health care
A health plan manager who is responsible for developing and managing the MCO's provider networks including such activities as recruiting, credentialing, contracting, service, and performance management for providers.
Industry:Health care
