An abbreviated reference to the American Medical Association guide to diagnosis codes, the International Classification of Diseases, 9th edition, Clinical Modification manual. Diagnosis codes are sometimes referred to as ICD-9-CM codes.
A procedure that is performed at the same time as a primary procedure and requires no additional physician resources.
Traditional fee-for-service health insurance in which members have free choice of physicians.
A written explanation from the provider requesting payment for procedures justified by unusual circumstances.
A child through 12 months.
Calculation of hospitalization time during which services are provided, including the day of admission and excluding the day of discharge.
Facility-based treatment given immediately before or right after an inpatient stay that may include transfers between facilities or to another unit within the same facility.
integrated health management
The combination of various cost-management programs, such as utilization management and disease management, to promote healthy lifestyles and encourage cost-effective delivery of care.
Bills sent at regular intervals for patients who have lengthy stays in a hospital or facility.
Inter-Plan Teleprocessing Services
A communications system, ITS provides an interface among all claims processing systems for Blue Cross and Blue Shield plans across the country. See also BlueCard.
Created by physician-led teams of health care professionals, these standards have been selected by BCBSM for prospective and retrospective utilization management programs to assess the appropriate level of care and the medical necessity of procedures.
Any procedure, treatment, supply, device or drug that has not received FDA approval or is not yet supported by the clinical community because the scientific evidence available does not demonstrate the effectiveness of the service or technology.