- 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.
The MCO committee that develops, updates, and administers the MCO's formulary and regularly reviews reports on clinical trials, drug utilization reports, current and proposed therapeutic guidelines, and economic data on drugs.
Industry:Health care
Legislation designed to protect commerce from unlawful restraint of trade, price discrimination, price fixing, reduced competition, and monopolies. See also Sherman Antitrust Act, Clayton Act, and Federal Trade Commission Act.
Industry:Health care
A type of managed care specialty service organization that seeks to contain the costs of prescription drugs or pharmaceuticals while promoting more efficient and safer drug use. Also known as a prescription benefit management plan.
Industry:Health care
The MCO committee that reviews member appeals related to medical management or coverage determinations.
Industry:Health care
A company, owned by a group of investors, that purchases physicians' practice assets, provides practice management services, and, in most cases, gives physicians a long-term contract to continue working in their practice and sometimes an equity (ownership) position in the company.
Industry:Health care
A process in which the parties to a dispute submit their dispute to an impartial third party for a final, binding decision.
Industry:Health care
A joint venture between a hospital and many or all of its admitting physicians whose primary purpose is contract negotiations with MCOs and marketing.
Industry:Health care
The method that an employer or other payer or purchaser uses to pay medical benefit costs and administrative expenses.
Industry:Health care
Term used to describe a provider organization that bears the insurance risk associated with the healthcare it provides.
Industry:Health care
