- 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 process of calculating the appropriate premium to charge purchasers, given the degree of risk represented by the individual or group, the expected costs to deliver medical services, and the expected marketability and competitiveness of the MCO's plan.
Industry:Health care
A computer network that provides access to a database of medical information. Also known as a health data network.
Industry:Health care
A type of operational integration that enables patients to receive a variety of healthcare services from the same organization or entity, which streamlines administrative processes and increases the potential for the delivery of high-quality health-care.
Industry:Health care
Change that is controlled, but rarely planned, and that can lead to positive, negative, or even unintended results.
Industry:Health care
A utilization and quality management mechanism designed to aid providers in making decisions about the most appropriate course of treatment for a specific clinical case.
Industry:Health care
A reduction in the price of a particular pharmaceutical obtained by a PBM from the pharmaceutical manufacturer.27
Industry:Health care
An organization that contracts with a state Medicaid agency as a fiscal intermediary.
Industry:Health care
