Filter
Top Products
75 11/2005
Glossary of BCBSGa, Health Care and
Managed Care Terms
Accreditation:
Certification that an organization meets the reviewing organization’s standards.
Examples: accreditation of HMOs by the National Committee for Quality Assurance
(NCQA) or accreditation of PPOs by the American Accreditation HealthCare
Commission/URAC.
Affiliate:
Those organizations or entities: 1) which are licensees of the Blue Cross and Blue
Shield Association; or 2) which are owned or controlled, directly or indirectly, by, or
under common control with, BCBSGa or its parent or subsidiary corporations; or 3) for
which BCBSGa may administer claims or benefits or arrange for benefits on behalf of
self-insured employers.
American Accreditation HealthCare Commission, Inc./Utilization Review Accreditation
Commission, Inc. (AAHCC/URAC):
An independent, not-for-profit corporation established in 1990 by organizations
representing the managed health care industry, health care providers, consumers,
and regulators to encourage more efficient and effective managed care.
Ancillary:
A term used to describe additional services performed related to care, such as lab
work, x-ray, and anesthesia.
Benefit:
The amount payable by an insurer or employee benefit plan to a claimant, assignee,
or beneficiary under the terms of the benefits contract.
Benefits Package:
A term informally used to refer to the employer’s benefit plan or to the benefit plan
options from which the employee can choose. “Benefits package” highlights the fact a
health benefits plan is a compilation of specific benefits.