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Level III codes, also called local codes, were developed by state Medicaid agencies, Medicare contractors, and private insurers for use in specific programs and jurisdictions. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructed CMS to adopt a standard coding systems for reporting medical transactions.
MIB aims to uncover errors, omissions, misrepresentations on insurance applications to reduce fraud and anti-selection or adverse selection.MIB Group, Inc. is a member-owned corporation operating in the United States and Canada since 1902.
The Council for Affordable Quality Healthcare, Inc. (CAQH) is a non-profit organization [4] incorporated in California as a mutual benefit corporation. It was first incorporated under the name Coalition for Affordable, Quality Healthcare, Inc., and then renamed the Council for Affordable Quality Healthcare, Inc. on August 8, 2002.
Blue Cross and Blue Shield insurance companies are licensees, independent of the association and traditionally of each other, [16] offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state.
by health care providers on prescriptions (however, the NPI will not replace requirements for the DEA number or state license number); by health plans in their internal provider files to process transactions and communicate with health care providers; by health plans to coordinate benefits with other health plans;
Despite the copyrighted nature of the CPT code sets, the use of the code is mandated by almost all health insurance payment and information systems, including the Centers for Medicare and Medicaid Services (CMS), and the data for the code sets appears in the Federal Register. It is necessary for most users of the CPT code (principally providers ...
The NAIC is not a regulator; while its members are the insurance commissioners (i.e., the chief insurance regulators) of each U.S. state and six territories, [1] the NAIC is a non-governmental organization that concerns itself with insurance regulatory matters but does not actually regulate. The states have not delegated their regulatory ...
BCBSMA has non-profit status as a health insurer [5] and has 2.8 million policyholders, the largest number of any insurer in Massachusetts, with most policyholders insured through employers. [6] The number of policyholders dropped slightly between the first and second quarters of 2011, due to the economy and layoffs. [7]