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A number of legislative and technological developments attempt to optimize the prior authorization process: [16] In 2011, the American Medical Association recommended a uniform prior authorization form with real-time electronic processing. The proposed process would involve a physician ordering a medical service, their staff completing a ...
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
BlueCross BlueShield of South Carolina (BlueCross) is an independent licensee of the Blue Cross and Blue Shield Association. [1] BlueCross serves 21.5 million people through private business and government contracts. [2] BlueCross has several subsidiaries, two of which are affiliates licensed with the Blue Cross and Blue Shield Association.
The prior authorization, or pre-certification process, requires healthcare providers to get coverage approval for certain non-emergency procedures. Cigna removes pre-authorization requirement for ...
In January 2016, Horizon BCBS announced their newest endeavor to improve care quality and lower costs through their Omnia Health Alliance. [citation needed] The new Omnia health insurance plans provide access to all of Horizon's network hospitals with some of them being designated as Tier 1 with greater cost savings for consumers.
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.
Blue Cross Blue Shield of Massachusetts (BCBSMA) is a state licensed nonprofit private health insurance company under the Blue Cross Blue Shield Association with headquarters in Boston. The Boston location located on 101 Huntington ave is currently under study as a pending Boston Landmark by the Boston Landmarks Commission .
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