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Blue Cross Blue Shie
ch. 13
| Term | Definition |
|---|---|
| Americal Hospital Association | national organizatoin that represents and serves all types of hospitals, healthcare networks, and their patients and communities,the AHA began as the accreditation agency for new prepaid hospitalizatoins plans in 1939. |
| Away From Home Care Program | provides continuous BCBS healthcare coverage for subscribers who will be out of their service areafor more than 90 consectuve days. |
| BCBS basic coverage | Blue Cross Blue Shield (BCBS) coverage for the following services hospitalization, dianostic laboratory services, x-rays, surgical fees, assistant surgeon fees, obstetric care, intensive care, newborn care, and chemotherapy for cancer. |
| BCBS MAJOR MEDICAL (MM) coverage | BCBS covergagefor the follwing services, in addition to basic coverage office, visists, outpatient nonsurgical treatment, physical and occupational therapy, purchase of durable medical equipment (DME), mental health visits,allergy testing and injections |
| BlueCard Program | program that allows BCBS subscribers to receive local Blue Plan healthcare benefits while traveling or livnig ouytside of their plan's area. |
| Blue Cross (BC) | insurance lan creaed in 1929 when Baylor University Hospital, in Dallas, TX, approached teachers to the Dalls school district with a plan that guranteed up to 21 days of hospitalization per year for subscribers and each dependent for a $6 annual premium. |
| Blue Cross Blue Shield (BCBS) | joint venture between Blue Cross and Blue Shield where the corporations shard one building and computer services but maintaned separate corporate identities. |
| Blue Shield (BS) | began as s reolution passed by the House of Delegates at an American Medial Association meetnig in 1938; incorporates a concpt of boluntary health insurance that encourages physicians to cooperate with prepaid health plans. |
| BlueWorldwide Expat | provdies global medial coverage for active employees and their dependents who spend more than six months outside the United States; any U.S. corporation with new or existing Blue coverage thaat sends members to work and reside outside the U.S. for six mo |
| coordinated home health and hospice care | allows patinets with this opton to elect an laternative to the acute care setting. |
| Federal Employee Health Benefits Program (FEHBP) | an employer-spnonsored health benefits program established by an ct of Congress in 1959, which now provides benefits to more than 9 million federalenrollees and dependents through contracts with about 300 thrid-party payers. |
| Federal Employee Health Benefits Program (FEHBP) | an employer-spnonsored health benefits program established by an ct of Congress in 1959, which now provides benefits to more than 9 million federalenrollees and dependents through contracts with about 300 thrid-party payers. |
| Federal Employee Program (FEP) | an employer-spnonsored health benefits program established by an ct of Congress in 1959, which now provides benefits to more than 9 million federalenrollees and dependents through contracts with about 300 thrid-party payers. |
| for-profit corporaton | pay taxes on profits generated by the corporation's for-profit enterprises and pays dividends to shareholders on after-tax profits. |
| Government-Wide Service Benefit Paln | phrase printed below the BCBS trademark on federal employee plan (FEP)insurance cards, which indicates that the enrollee has federal employer-sponsored health benefits. |
| Healthcare Anywhere | BCBS program that allows members of independently owned and operated plans to have access to healthcare benefits throughout the United States and around the world. |
| indemnity coverage | offers choice and flexibility to subscribers who want to receive a full range of benefits along with the freedom to use any licensed healthcare provider. |
| medical emergency care rider | covers immediate treatment sought and received for sudden, severe, and unexpeced conditions that, if not treated, would place the patient's health i npermanent jeopardy or cause permanent impairment or dysfunction of an organ or body part. |
| Medicare supplemental plans | argument the Medicare program by paing for Medicare deductible and copayments. |
| member | subscriber. |
| member hospital | hospital that has signed a contract to provdie services for psecial rates. |
| nonprofit corporation | charitable,educational,civic, or humanitarian organization whose profits are returned to the program of the corporation rather than distributed to shareholders and officers of the corporation. |
| outpatient pretreatment authorization plan (OPAP) | requires preauthorization of outpatient physical, occupational, and speech therapy services. |
| PPN provider | provider who ahs signed a PPN contract and agrees to accept the PPN allowed rate, which is generally 10 percent lower than the PAR allowed rate. |
| precertification | prior approval. |
| preferred provider network (PPN) | program that requires provdiers to adhere to managed care provision. |
| prepaid health plan | contract between employer and healthcare facility for physician when specified medical services were performed for a predetermined fee that was paid on either a monthly or yearly basis. |
| prospective authorization | (outpatient pretreatment athorization plan(OPAP) |
| rider | special contract clause stipulating additional coverageabove the standard contract. |
| second surgical opinion (SSO) | second physician is askedto evaluate thenecessity of surgery and recomment the most economical, appropriate facility in which to perform the surgery (e.g., outpatient clinic or doctor's office versus inpatient hospitalization). |
| service location | location where the patient was seen. |
| special accidental injury rider | covers 100 percent of nonsurgical care sought and rendered within 24 to 72 hours (varies according to policy) of teh accidental injury. |
| usual, customary, and reasonable (UCR) | decription of amount commonly charged for a particular medical service by providers withinb a particular geographic region; used for establishing allowable rates. |
| Camelia Clark Reimbursement | 06-13-13 |
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cameliaclark