- 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.
An organization-wide process of measuring and improving the quality of the healthcare provided by an MCO.
Industry:Health care
A market segment that includes groups of two or more people who enter into a group contract with an MCO under which the MCO provides healthcare coverage to the members of the group.
Industry:Health care
The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim.
Industry:Health care
The MCO committee that oversees the organization's quality assessment and improvement activities in both clinical and non-clinical areas.
Industry:Health care
A legal entity that combines multiple independent physician practices under one umbrella organization and performs certain business operations for the member practices or arranges for these operations to be performed. The GPWW may maintain its own facility for business operations or it may hire another company to provide this function. Also known as a clinic without walls.
Industry:Health care
Employees in the claims administration department who oversee the work of several claims examiners.
Industry:Health care
Change that is unplanned and uncontrolled and produces unpredictable results. Also known as random change.
Industry:Health care
The difference between the highest and lowest rates that a health plan charges small groups. The National Association of Insurance Commissioners' Small Group Model Act limits a plan's allowable rate spread to 2 to 1.
Industry:Health care
