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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 ...
In 1985, The two companies merged into Associated Insurance Companies, Inc,, later called, The Associated Group, a holding company, but usage of the name "Anthem" persisted. [10] In 1989, the company purchased American General Insurance Co. for $150 million and in 1991, it acquired The Shelby Insurance Co., based in Shelby, Ohio, for $125 million.
A survey issued in 2009 by America's Health Insurance Plans found that patients going to out-of-network providers are sometimes charged extremely high fees. [117] [118] Network-based plans may be either closed or open. With a closed network, enrollees' expenses are generally only covered when they go to network providers.
The provider network is required to include sufficient primary care physicians to serve its enrollees. [17] The ACO must define processes to promote evidence-based medicine and patient engagement, monitor and evaluate quality and cost measures, meet patient-centeredness criteria and coordinate care across the care continuum. Prior to applying ...
Five factors that can be used to assess the advancement level of a particular IDN include provider alignment, continuum of care, regional presence, clinical integration, and reimbursement. [ 5 ] Between 2013 and 2017, healthcare providers created 11 new integrated delivery systems from joint ventures with insurance companies.
McKesson Provider Technologies is the retail name for McKesson Technology Solutions; the software development division of McKesson. Their customer base in the United States includes 50% of all health systems, 20% of all physician practices, 25% of home care agencies, and 77% of health systems with more than 200 beds.
LOMA administers a series of designation programs. The Fellow, Life Management Institute (FLMI) designation program, awards the FLMI designation to individuals who pass a series of 10 examinations; these insurance-focused examinations cover insurance, accounting, marketing, information systems, finance, law, management, and computers. [6]
In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.