A system designed for hospital and facility providers, the Hospital Access and Response Terminal provides information about members, including eligibility, benefits and claims.
The Centers for Medicare and Medicaid Services standard form for submitting professional services to third-party companies or insurance carriers. This form has largely replaced the Michigan Health Benefits Claim.
Alphanumeric codes in the Common Procedure Coding System used by the Centers for Medicare and Medicaid Services to report services provided to Medicare and Medicaid beneficiaries. BCBSM uses these codes for nonphysician procedures, such as ambulance services, durable medical equipment and medical supplies.health maintenance organization See HMO.
Healthcare Effectiveness Data and Information Set
A program that provides member savings and special offers on a variety of healthy products and services from local Michigan businesses (see Blue365® for national discount offerings).
Health Security Program
A credit plan under which BCBSM pays the patient’s deductible and copayment and later recovers the payment through an arrangement with the patient, the group or a financial institution.
A comprehensive set of performance indicators, the Healthcare Effectiveness Data and Information Set ensures that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans. HEDIS measures are sponsored, supported and maintained by the National Committee for Quality Assurance, a not-for-profit organization committed to evaluating and publicly reporting on the quality of managed care plans.
A federal law affecting all participants in the country’s health care system, the Health Insurance Portability and Accountability Act of 1996 was developed to improve the portability of coverage for people who lose or change employment, to promote administrative simplification through the use of electronic transactions and to ensure the security and privacy of member information.
A state-licensed health maintenance organization that delivers physician and hospital services to members directly or through contracts with affiliated providers. The plan requires members to choose a network provider (a primary care physician) to coordinate their health care.
One of several ways to define the relationship between the health plan and its providers:
- Group — a multispecialty practice of professional and institutional providers
- Independent practice association — a financial organization of individual physicians who provide health care to members
- Network — a health plan that contracts with physician groups as well as with hospitals and other health care providers
- Staff — a facility that employs physicians and other health care providers to care for members
home health care
An array of services provided directly in the home under medical and nursing direction and supervision.
The Blue Cross and Blue Shield plan where the member is enrolled. The term is usually used in connection with services received under the BlueCard program.
Hospital Access and Response Terminal system
Health care provider, usually a physician, whose practice is devoted to treating patients in a hospital setting.
The Blue Cross and Blue Shield plan serving the area where a member of another Blue Cross and Blue Shield plan receives services.