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Where was the first known plan of BCBS? Palo Alto, California 1939.
When did Blue Cross Blue Sheild merge under single president? 1977
What is a Non-Profit? They pay no taxes. they are charitable, they returned to program instead of shareholders and office coorporations.
What is a For-Profit? They pay taxes on profits generated by the coorporation.
BCBS Contracts do what? -Make prompt direct payments -Maintain regional professional rep to participate providers w/ claims
Connot cancel/forbidden - Poor Health - Exceeding the average
What are BCBS Plans? -Fee-For-Service -Managed care plans -Federal Employee Programs -Medicare Supplement Plans -Health care anywhere
Fee-for-Service (Traditional Coverage) Basic and Major Medical
Basic coverage covers? Hospitalizations, x-rays, surgical, obgyn, chemo, newborn, and intensive care.
Major Medical covers? office visits, mental health visits, allergy testing injections, outpatient, durable medical equip., persciption drugs
Riders treat you additional coverage over and above standard contract accidental injury
Special accidental injury rider emergency care with in 24-72 hours of accidental injury
Indemnity coverage offers choice and flexibility
Home health care and Hospice alternatives to traditional hospital
outpatient pretreatment authorization plan (OPAP) requires preauthorization of outpatient- aka prospective aurthorization or percertification
Member is the policyholder
Mandatory Second Surgical Opinion (SSO) for elective nonemergency surgical care
Federal Health Benefits Program (Federal Employee Program) use a three digit enrollment code for ID, Front
Medicare Supplemental Plans Medigap
Healthcare Anywhere coverage throughout US
Away From Home Care Program allows those residing outside their home at least 90 days enroll with loval HMO
Claims Processing BCBS palns process their own claims, deadline filling 1year CMS 1500 form is used
Free schedules charts documented charges each procedure use a plan called usual, customary, and reasonable.
Assignment of benefits Payment made dirctly to the provider
Purchase noncancelation plan clause can not be dropped
ICD- 9 Codes Doctor can have up to 4 codes and they are listed in order of severity
CPT Current procedural terminology descending order of complexity
Created by: hannahpippel
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