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Third-party administrators are prominent players in the health care industry and have the expertise and capability to administer all or a portion of the claims process. They are normally contracted by a health insurer or self-insuring companies to administer services, including claims administration, premium collection, enrollment and other ...
In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans.
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 ...
While some large employers self-administer their self-funded group health plan, most find it necessary to contract with a third party for assistance in claims adjudication and payment. Third party administrators (TPAs) provide these and other services, such as access to preferred provider networks, prescription drug card programs, utilization ...
Mark Bertolini, chief executive officer of Oscar Health and previous CEO of Aetna [1] Gail Koziara Boudreaux , chief executive officer and president of Elevance Health [ 2 ] Thomas B. Considine , chief executive officer of the National Conference of Insurance Legislators and former chief operating officer of MagnaCare [ 3 ]
Aug. 31—HUNTINGTON, W.Va. — Angela Myhrwold has been named department administrator for Marshall Psychiatry. She joined Marshall Health in 2015 as an operations analyst before being named ...
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In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. [1] It is an organization that provides or arranges managed care for health insurance , self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care ...