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As Highmark Blue Shield, it is available in 21 counties in Central Pennsylvania and the Lehigh Valley. It also has a presence in the border areas of eastern Ohio, and all of West Virginia through its subsidiary, Highmark Blue Cross Blue Shield West Virginia. Highmark acquired Blue Cross of Northeastern Pennsylvania, BCNEPA, in June 2015. [4] [5]
In 1982, Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association (BCBS). [11] Prior to 1986, organizations administering BCBS were tax exempt under 501(c)(4) as social welfare plans. The Tax Reform Act of 1986 revoked the exemption, however, because the plans sold commercial-type insurance.
The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual. [5] At this point, the medical service may be approved or rejected, or additional information may be requested.
Many professional designations in the United States take the form of post-nominal letters. Certifications are usually awarded by professional societies or educational institutes. Certifications are usually awarded by professional societies or educational institutes.
The National Uniform Billing Committee (NUBC) is the governing body for forms and codes use in medical claims billing in the United States for institutional providers like hospitals, nursing homes, hospice, home health agencies, and other providers. The NUBC was formed by the American Hospital Association (AHA) in 1975. [3]
In 1964, the company changed its name to Blue Cross of Greater Philadelphia and in 1988, began doing business as Independence Blue Cross. [ 3 ] In October 2011, Independence launched a private, charitable foundation — the Independence Blue Cross Foundation, with a mission to transform health care through innovation in the communities it ...
CareFirst BlueCross BlueShield is a health insurance provider serving 3.5 million individuals and groups in Maryland and the Washington metropolitan area.It has dual headquarters in Baltimore, Maryland and Washington, D.C. [2] [3] It is a nonprofit organization and an independent licensee of the Blue Cross Blue Shield Association.
Keystone First is a medical assistance (Medicaid and Medicare) managed care health plan based in southeastern Pennsylvania. Keystone focuses on low-income residents in southeastern Pennsylvania counties including, Bucks, Chester, Delaware, Montgomery, and Philadelphia. The healthcare provider currently serves over 400,000 residents in the area. [1]