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Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, provides and administers health benefits to more than 4.3 million members residing in Michigan in addition to members of Michigan-headquartered groups who reside outside the state. In 1998, BCBSM merged several HMOs it owned into the Blue Care Network HMO. [2]
Nevertheless, according to the trade association America's Health Insurance Plans, 90 percent of insured Americans are now enrolled in plans with some form of managed care. [11] The National Directory of Managed Care Organizations, Sixth Edition profiles more than 5,000 plans, including new consumer-driven health plans and health savings accounts.
After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual. [5]
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
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 ...
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2009: Grupo Triple-S celebrates its 50th anniversary and renews its corporate identity. Triple-S Salud, Inc. completes the purchase of certain managed care assets of La Cruz Azul de Puerto Rico and is awarded the Blue Cross license, thereby becoming in the Blue Cross Blue Shield Association licensee of Puerto Rico and the US Virgin Islands.
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