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In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...
Healthcare professional credentials are credentials awarded to many healthcare practitioners as a way to standardize the level of education and ability to provide care. Clinicians [ edit ]
A medical license is an occupational license that permits a person to legally practice medicine.In most countries, a person must have a medical license bestowed either by a specified government-approved professional association or a government agency before they can practice medicine.
The Knox-Keene Health Care Service Plan Act of 1975 is a set of Californian laws that regulate Healthcare Service Plans. Under these laws, pharmacy benefit managers with contracts to Health care service plans are required by law to be registered with the Department of Managed Health Care to disclose information. [58] SB 966: Pharmacy benefits
A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often receive payments for their services rendered from health insurance providers.
The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks.
The system consists of 15 hospitals, 200+ ambulatory sites, hospice, home health, medical equipment and other health services spanning 47 Ohio counties. [1] As of May 2020, the organization has 35,000 physicians, associates, and volunteers, with more than $4.3 billion in net revenue.
In 1939, Blue Cross Plans united to form the Blue Cross Association [7] In 1956, Medical Mutual of Cleveland was formed to provide coverage for doctor fees. CHSA merged with Akron Hospital Service to form Blue Cross of Northeast Ohio in 1957, and four years later, Medical Mutual of Cleveland became affiliated with the Blue Shield system.