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Blue Cross and Blue Shield insurance companies are licensees, independent of the association and traditionally of each other, [16] offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state.
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.
In 1996, The Associated Group changed its name to Anthem Insurance Company. [17] In August 1997, Anthem acquired Blue Cross and Blue Shield of Connecticut. [18] It also sold Acordia to management. [19] In 1999, Anthem acquired Blue Cross and Blue Shield of New Hampshire and Blue Cross and Blue Shield of Colorado and Nevada. The acquisitions ...
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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 ...
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Pennie is the official health insurance marketplace in the U.S. state of Pennsylvania established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals to purchase private health insurance coverage at federally subsidized rates.