- 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 cost containment program that recovers money where primary responsibility does not exist because of another group health plan or contractual exclusions. Includes coordination of benefits, Workers' Compensation, subrogation and no-fault auto insurance.
Industry:Health care
A market segment that consists of customers who are covered under an individual contract for health coverage or enrolled in a government program.
Industry:Health care
An ethical principle which, when applied to managed care, states that managed care organizations and their providers are obligated not to harm their members.18
Industry:Health care
A plan under which an employer's group health plan, disability plan, and workers' compensation program are merged, integrated, or coordinated (depending on state regulations) into a single health benefit plan that covers employees 24 hours a day.
Industry:Health care
The application of managed care principles to 24-hour coverage.
Industry:Health care
A provision that specifies that plan members may self-refer to a specialist, either in-network or out-of-network, at full benefit or at a reduced benefit, without first obtaining a referral from a primary care provider.
Industry:Health care
The provision that drugs on the preferred list and those not on the preferred list will both be covered by a PBM or MCO.19
Industry:Health care
An evaluative process in which a health care organization undergoes an examination of its operating procedures to determine whether the procedures meet designated criteria as defined by the accrediting body, and to ensure that the organization meets a specified level of quality.1
Industry:Health care
