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Glossary

  1. C

    Call abandonment rate
    A measure of how often members hang up before receiving assistance when they make telephone calls to a company and are put on hold.
    claim
    An itemized statement of healthcare services and their costs provided by a hospital, physician's office or other provider facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.
    claim form

    An application for payment of benefits under a health plan. International claim forms are located here. For other claim forms, please see your local Blue Cross and Blue Shield companies.

    claims investigation
    The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim.
    clinic model
    See consolidated medical group.
    clinic without walls
    See group practice without walls.
    clinical practice guideline
    A utilization and quality management mechanism designed to aid providers in making decisions about the most appropriate course of treatment for a specific clinical case.
    CMP
    See competitive medical plan.
    COBRA
    See Consolidated Omnibus Budget Reconciliation Act.
    coding errors
    Documentation errors in which a treatment is miscoded or the codes used to describe procedures do not match those used to identify the diagnosis.
    Coinsurance
    A provision in a member's coverage that limits the amount of coverage by the plan to a certain percentage, commonly 80 percent. Any additional costs are paid by the member out of pocket.
    contract management system
    An information system that incorporates membership data and provider reimbursement arrangements and analyzes transactions according to contract rules.
    coordinated care plans (CCPs)
    The Medicare+Choice delivery option that includes HMOs (with or without a point-of-service component), preferred provider organizations (PPOs), and provider-sponsored organizations (PSOs).
    copayment
    A specified dollar amount that a member must pay out-of-pocket for a specified service at the time the service is rendered. .