- 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.
In group health insurance, generally a condition for which an individual received medical care during the three months immediately prior to the effective date of coverage.
Industry:Health care
A method of planning and implementing quality management programs that consists of identifying the best practices and best outcomes for a specific process and emulating the best practices to equal or surpass the best outcomes.
Industry:Health care
As defined in state laws, a contract between a healthcare insurer and a healthcare provider or group of providers who agree to provide services to persons covered under the contract. Examples include preferred provider organizations (PPOs) and exclusive provider organizations (EPOs).
Industry:Health care
An ethical principle which, when applied to managed care, states that each member should be treated in a manner that respects his or her own goals and values and that MCOs and their providers have a duty to promote the good of the members as a group.4
Industry:Health care
A healthcare benefit arrangement designed to supply services at a discounted cost by providing incentives for members to use designated healthcare providers (who contract with the PPO at a discount), but which also provides coverage for services rendered by healthcare providers who are not part of the PPO network.
Industry:Health care
The process an MCO uses to determine which benefits or the level of benefits that will be offered to its members, the degree to which members will be expected to share the costs of such benefits, and how a member can access medical care through the health plan.
Industry:Health care
A prepaid payment or series of payments made to a health plan by purchasers, and often plan members, for medical benefits.
Industry:Health care
Actual practices, in use by qualified providers following the latest treatment modalities, that produce the best measurable results on a given dimension.
Industry:Health care
For groups with limited recorded claim experience, a method of forecasting a group's cost of benefits based partly on an MCO's manual rates and partly on the group's experience.
Industry:Health care
