Glossary
The information within Find A Doctor is updated daily. However, before you receive services from providers, you should always contact them to make sure they are still participating in the network and that their information is up-to-date.
Accepting New Patients
Shows whether a doctor is accepting new patients in a specific network or not. A doctor who is not accepting new patients should still be able to see you if you are already their patient. This information is submitted directly by doctors when they apply to join our network. Blue Cross Blue Shield of Massachusetts makes changes to provider data as we are made aware of them. We outreach to providers each quarter, asking them to validate their data and encouraging them to notify us of any changes to their information.
Accreditation
Accreditation is a certification that indicates a hospital meets certain standards. In order to be accredited, a hospital must undergo an evaluation process based on a set of quality standards set by organizations such as The Joint Commission. The Joint Commission surveys and evaluates accredited hospitals at least once every three years for reaccreditation, using guidelines that ensure patients receive the highest quality care possible. The status of accredited hospitals is verified during the initial credentialing process. We update the accreditation status whenever we’re notified of changes and re-confirm it routinely every two years. For more information on specific hospitals, please go to http://www.qualitycheck.org/consumer/searchQCR.aspx.
Acute Residential Treatment for Children and Adolescents
Acute Residential Treatment for Children and Adolescents refers to the following services for patients under 19:
- Community-based acute treatment for children and adolescents
- Intensive community-based acute treatment for children and adolescents
These services are an alternative to acute inpatient care providing treatments in a sub-acute setting.
Board Certified
Board-certified doctors have completed additional clinical training in their area of expertise. To receive this designation, they have passed oral and/or written examinations that document their competency in a given specialty. This is not applicable to ancillary doctors (examples: diagnostic, therapeutic, and custodial care providers). For more information, please see Certification Matters™. Doctors report their board-certification status to us when they apply to join our network. We verify the status with the appropriate board and reconfirm every two years. We also update the information whenever we’re notified of any changes.
Community-Based Acute Treatment for Children and Adolescents
Community-Based Acute Treatment for Children and Adolescents is a residential program that provides intensive therapeutic services in a secure setting. The program may be an alternative to inpatient behavioral health services. For help finding the right care for you or your child, call 1-800-821-1388.
Electronic Medical Records
Indicates your doctor has an immediately accessible electronic version of your medical record, including diagnoses, medications, allergies, test results, and your medical history.
e-Prescriber
Allows your doctor to send an electronic prescription directly to your pharmacy.
Family Support and Training for Children and Adolescents
Family Support and Training provides medically necessary services to a parent or other caregiver of a child so the caregiver can better meet the child’s emotional or behavioral needs. The support and training may include teaching the caregiver how to navigate services to get help for the child and how to find informal services and community support, including parent support and self-help groups. For help finding the right care for you or your child, call 1-800-821-1388.
Fee-for-service
We pay some health care providers on a fee-for-service basis, meaning we pay them each time you get care.
Gender
Shows whether a health care professional is a man or a woman. This information is submitted by health care professionals when they apply to join our network. Blue Cross Blue Shield of Massachusetts makes changes to provider data as we are made aware of them. We outreach to providers each quarter, asking them to validate their data and encouraging them to notify us of any changes to their information.
Hospital Affiliations
Health care professionals sometimes have a relationship with a hospital, allowing them admitting and attending privileges. We encourage you to compare the cost and quality of the hospitals as results may differ. Hospital affiliations are submitted by health care professionals when they apply to join our network. We update the information whenever we’re notified of changes and reconfirm it every two years.
In-Home Behavioral Services for Children and Adolescents
In-Home Behavioral Services include monitoring and assessing a child or adolescent’s behavior as well as therapy to address behaviors that may get in the way of the child or adolescent’s everyday life. A team of providers works with the child or adolescent and their family to develop and implement a plan for improving the child’s behavior. For help finding the right care for you or your child, call 1-800-821-1388.
In-Home Therapy for Children and Adolescents
In-Home Therapy provides in-home therapeutic support to a child or adolescent with their social skills and behavioral health needs, as well as improve their family’s ability to provide effective emotional support to the child. For help finding the right care for you or your child, call 1-800-821-1388.
Intensive Care Coordination for Children and Adolescents
Intensive Care Coordination helps coordinate the services provided to children or adolescents with serious emotional or behavioral needs. That way all providers are working together to meet the medical, behavioral health, and social needs of the child and their family. For help finding the right care for you or your child, call 1-800-821-1388.
Intensive Community-Based Treatment for Children and Adolescents
Intensive Community Based Treatments (in-home outpatient services) for Children and Adolescents refer to the following services for patients under 19:
- Intensive care coordination,
- In-home behavioral services
- In-home therapy
In-home behavioral services include behavioral management monitoring and behavioral management therapy. In-home therapy includes therapeutic clinical intervention and ongoing therapeutic training and support. For help finding the right care for you or your child, call
1-800-821-1388.
Intensive Community-Based Acute Treatment for Children and Adolescents
Intensive Community-Based Acute Treatment for Children and Adolescents is a residential program that provides intensive therapeutic services in a secure setting. Intensive Community-Based Acute Treatment for Children and Adolescents provides the same services as Community-Based Treatment for Children and Adolescents but of a higher intensity, including more staffing and evaluations. The program may be an alternative to inpatient behavioral health services. For help finding the right care for you or your child, call 1-800-821-1388.
Languages Spoken
Health care professionals list the languages they speak on their credentialing application. They can also supply interpreter services for their patients. This information is submitted by health care professionals when they apply to join our network. Blue Cross Blue Shield of Massachusetts makes changes to provider data as we are made aware of them. We outreach to providers each quarter, asking them to validate their data and encouraging them to notify us of any changes to their information.
Medical Group
A group of doctors who manage a practice and are contracted with Blue Cross to provide services to our members. This information is submitted by doctors when they apply to join our network. Blue Cross Blue Shield of Massachusetts makes changes to provider data as we are made aware of them. We outreach to providers each quarter, asking them to validate their data and encouraging them to notify us of any changes to their information.
Mobile Crisis Intervention
Mobile Crisis Intervention provides urgent care for behavioral health. It is a short-term, mobile, on-site, face-to-face therapeutic response service that is available 24 hours a day, 7 days a week to patients experiencing a behavioral health crisis. Mobile Crisis Intervention is used to identify, assess, treat and stabilize a situation, to reduce the immediate risk of danger to the patient or others, and to make referrals and linkages to all medically necessary behavioral health services and supports and the appropriate level of care. For help finding the right care for you or your child, call 1-800-821-1388.
Name
The name that appears on the provider’s professional license. For facilities, it’s the legal name or “doing business as” name from the provider’s contract. This information is submitted by providers when they apply to join our network. We update the information whenever we’re notified of changes and reconfirm it every two years.
Performance-based incentives
Doctors are rewarded based on positive patient outcomes, rather than solely reimbursing them for the number of services they provide. Doctors can earn higher payments based on how well they perform on a set of nationally recognized, clinical-quality measures. They are also responsible for managing the total cost of care for their Blue Cross patients.
Phone Number
The provider’s practice phone number, whether located in an office, a hospital, or another medical facility. This information is submitted by providers when they apply to join our network. Blue Cross Blue Shield of Massachusetts makes changes to provider data as we are made aware of them. We remind providers each quarter to validate their directory data and encourage them to notify us of any changes to their information.
Provider
A provider is a licensed health care facility, program, agency, doctor, or other health professional that delivers health care services. Providers may also be certified and recognized under state law.
Provider Location
The provider’s practice address, whether located in an office, a hospital, or another medical facility. This information is submitted by providers when they apply to join our network. Blue Cross Blue Shield of Massachusetts makes changes to provider data as we are made aware of them. We remind providers each quarter to validate their directory data and encourage them to notify us of any changes to their information.
Relative Price
Relative price is a calculated metric that measures provider price variation in the Massachusetts health care market. It compares different provider prices within a payer’s network for a standard mix of insurance products (e.g. HMO, PPO, and Indemnity) to the average of all providers’ prices in that network. For more information on Relative Price, please go to http://www.chiamass.gov/relative-price-and-provider-price-variation/.
Specialty
Providers may limit their practice to a specific branch of medicine or surgery, such as internal medicine, orthopedics, or gastroenterology. This is known as a “specialty.” This information is submitted by providers when they apply to join our network. We update the information whenever we’re notified of changes and reconfirm it every two years.
Community mental health centers and behavioral health hospitals may have additional information pertaining to services they offer listed as a specialty, but this information is self-reported. Other self-reported information includes ages treated, treatment methods, disorders treated, and subspecialties/areas of expertise for behavioral health providers, lactation counseling services, telehealth services, disability access, TTY availability, accessibility by public transportation, and the availability of evening and weekend office hours. You should always confirm this information with the provider before making an appointment.
Standard Quality Measure Set
The Massachusetts Statewide Quality Advisory Committee (SQAC), which was established by Chapter 288 of the Acts of 2010 and reestablished by Chapter 224 of the Acts of 2012, is comprised of various experts in the health care industry and is tasked with recommending a Standard Quality Measure Set (SQMS). The SQMS covers a variety of clinical areas, such as preventive health, chronic disease management, pediatric, maternal and neonatal health, mental health, and substance abuse, and also includes measures mandated by the State Legislature. For more information on the SQMS, please go to https://www.chiamass.gov/sqms/.
Telehealth
A live video visit with a health care provider using a smartphone, tablet, or computer. It offers a convenient way to have a brief visit with a doctor or therapist, simply and easily.
Therapeutic Mentoring Services for Children and Adolescents
Therapeutic Mentoring Services provide medically necessary services to help a child learn and practice social and communication skills so the child can relate appropriately to other children and adolescents and to adults. For help finding the right care for you or your child, call 1-800-821-1388.
Total Medical Expense
Total Medical Expense (TME) represents the full amount paid to providers for health care services delivered to a payer’s member population, expressed on a per member per month (PMPM) basis. TME includes the amounts paid by the payer and patient cost-sharing, and covers all categories of medical expenses and all non-claims related payments to providers, including provider performance payments. For more information on TME, please go to http://www.chiamass.gov/thce-tme-apm/
Urgent Care Center
Urgent care centers can provide medical care when your provider is not available and you don’t have a true emergency. They can help with sprains, X-rays, and minor cuts and injuries. You can usually go to an urgent care center in the evenings and on weekends. Typically, visits to urgent care centers result in lower out-of-pocket costs, compared to visits to emergency rooms.