The National Accounts Service Company connects several Blue Cross and Blue Shield plans across the country through a common automated system to administer health benefit programs.
A group whose subscribers live in more than one Blue Cross or Blue Shield plan service area.
A nationally recognized independent organization, the National Committee for Quality Assurance evaluates managed care plan performance using objective, scientific measures, such as HEDIS, the Healthcare Effectiveness Data and Information Set.
The Blues preferred term for a group of physicians, hospitals and other health care providers under contract to offer care at negotiated rates to its managed care members.
Insurance purchased by the individual subscriber rather than a group. See also other-than-group coverage.
Providers who have not signed a participation agreement with the Blues to accept our approved charge as payment in full.
Code for a message explaining why payment for a medical service was reduced or denied.
nurse care managers
Licensed registered nurses who have received specific training and education in disease management and help patients receive the most efficient and effective care while coordinating their benefits.