- 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 a self-funded plan, the account into which the money that an employer and employees would have paid in premiums to an insurer or MCO is deposited until the money is paid out.
Industry:Health care
The process of receiving, reviewing, adjudicating, and processing claims.
Industry:Health care
In a managed care context, an MCO's success in providing health-care and other services in such a way that plan members' needs and expectations are met.
Industry:Health care
The dispensing of a drug that is the generic equivalent of a drug listed on a pharmacy benefit management plan's formulary. In most cases, generic substitution can be performed without physician approval.12
Industry:Health care
A Health Care Financing Administration program designed to strengthen MCOs' efforts to protect and improve the health and satisfaction of Medicare and Medicaid enrollees.26
Industry:Health care
The number of primary care providers within a given radius of a particular target.
Industry:Health care
Employees in the claims administration department who consider all the information pertinent to a claim and make decisions about the MCO's payment of the claim. Also known as claims analysts.
Industry:Health care
