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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. .
