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Administrative data are electronic records of services, including insurance claims and registration systems from hospitals, clinics, medical offices, pharmacies and labs. For example, a measure titled Childhood Immunization Status requires health plans to identify 2-year-old children who have been enrolled for at least a year.
Health care ratings are ratings or evaluations of health care. In the United States they have been an increasingly used tool to try to drive accountability among health care providers and in the context of classic supply / demand view of Health economics , to help health care consumers make better choices.
CAQH was formed by a number of the nation's largest health insurance companies with the goal of creating a forum for healthcare industry stakeholders to discuss administrative burdens for physicians, patients, and payers. [5] CAQH is a group of health insurance companies that sets rules and coordinates information for physicians and other ...
The plan also states that insurance companies cannot use more restrictive prior authorization or narrower networks to make it more difficult for people to access mental health and substance use ...
Insurance companies may determine treatment is not appropriate or the cheapest first option and deny coverage until a doctor files the right code or selects a treatment within the company's ...
The merger created a single online company with more than 200 million visitors annually. [14] In October 2014, Healthgrades launched the first comprehensive physician rating and comparison database in the United States. [8] The database allows users to search for physicians based on their experience in a particular area or procedure. [8]
AM Best is an American credit rating agency headquartered in Oldwick, New Jersey, that focuses on the insurance industry. Both the U.S. Securities and Exchange Commission and the National Association of Insurance Commissioners have designated the company as a Nationally Recognized Statistical Rating Organization (NRSRO) in the United States. [1 ...
The Cigna Group is an American multinational for-profit managed healthcare and insurance company based in Bloomfield, Connecticut. [2] [3] Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups (e.g., governmental and non-governmental ...