- 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 patient who has a complex or catastrophic illness or injury or who requires extensive medical interventions or treatment plans.
Industry:Health care
A person, location, or device furnished by a company to deliver information or services to customers.
Industry:Health care
A type of utilization review that occurs after treatment is completed in order to authorize payment and medical necessity and appropriateness of care.
Industry:Health care
A contract clause which forbids providers from seeking compensation from patients if the health plan fails to compensate the providers because of insolvency or for any other reason.
Industry:Health care
A rating method that sets premiums for financing medical care according to the health plan's expected costs of providing medical benefits to the community as a whole rather than to any sub-group within the community. Both low-risk and high-risk classes are factored into community rating, which spreads the expected medical care costs across the entire community.
Industry:Health care
The amounts earned from a company's sales of products and services to its customers.
Industry:Health care
A company whose sole business is the ownership of other companies, which are its subsidiaries.
Industry:Health care
The process of determining premium rates in which a managed care organization categorizes its members into classes or groups based on demographic factors, industry characteristics, or experience and charges the same premium to all members of the same class or group.
Industry:Health care
The statistical adjustment of outcomes measures to account for risk factors that are independent of the quality of care provided and beyond the control of the plan or provider, such as the patient's gender and age, the seriousness of the patient's condition, and any other illnesses the patient might have. Also known as case-mix adjustment.
Industry:Health care
An illegal business practice that occurs when two or more organizations agree not to compete by dividing geographic marketing areas, product offerings, or customers.
Industry:Health care
