vocabulary:
  name: Triple-S Management Vocabulary
  description: >-
    Domain vocabulary for Triple-S Management Corporation, the largest managed care
    company in Puerto Rico, covering health insurance, managed care, Medicare Advantage,
    and healthcare provider terminology.
  version: 1.0.0
  created: '2026-05-03'
  modified: '2026-05-03'
  tags:
    - Health Insurance
    - Managed Care
    - Puerto Rico
    - Healthcare

terms:
  - term: Managed Care
    definition: >-
      A healthcare delivery system organized to manage cost, utilization, and quality
      of care. Triple-S Salud operates as the primary managed care organization in
      Puerto Rico.
    category: Core Concept
    tags:
      - Healthcare
      - Insurance

  - term: Medicare Advantage
    definition: >-
      A type of Medicare health plan offered by private companies approved by Medicare.
      Triple-S Advantage provides Medicare Advantage plans in Puerto Rico.
    category: Insurance Product
    tags:
      - Medicare
      - Insurance

  - term: Blue Cross Blue Shield
    definition: >-
      A federation of health insurance organizations and companies. Triple-S Salud is
      an independent licensee of the Blue Cross Blue Shield Association for Puerto Rico
      and the U.S. Virgin Islands.
    category: Association
    tags:
      - Blue Cross Blue Shield
      - Insurance

  - term: EDI 837
    definition: >-
      Electronic Data Interchange format for submitting healthcare claim transactions
      electronically. Triple-S providers use EDI 837 for electronic claims submission.
    category: Technical Standard
    tags:
      - EDI
      - Claims

  - term: Prior Authorization
    definition: >-
      A requirement from Triple-S that providers obtain approval before delivering
      certain medical services or prescribing medications to ensure coverage eligibility.
    category: Clinical Process
    tags:
      - Authorization
      - Healthcare

  - term: Explanation of Payment (EOP)
    definition: >-
      A document sent to healthcare providers explaining how a claim was processed
      and what payment amount was issued or denied.
    category: Claims
    tags:
      - Claims
      - Payments

  - term: Credentialing
    definition: >-
      The process of verifying a provider's qualifications, licenses, and background
      before they can participate in Triple-S networks.
    category: Provider Management
    tags:
      - Providers
      - Credentialing

  - term: IPA (Independent Practice Association)
    definition: >-
      An association of independent physicians and other healthcare providers organized
      to negotiate contracts with managed care organizations. CarePoint is Triple-S's IPA.
    category: Provider Organization
    tags:
      - Providers
      - Healthcare

  - term: GuideWell
    definition: >-
      The parent company of Florida Blue that acquired Triple-S Management Corporation
      in February 2022, enabling expanded healthcare reach across Florida and Puerto Rico.
    category: Corporate
    tags:
      - Corporate
      - Insurance

  - term: Triple-S Salud
    definition: >-
      The managed care health insurance subsidiary of Triple-S Management, serving
      individual, employer, and government health plan markets in Puerto Rico.
    category: Subsidiary
    tags:
      - Healthcare
      - Insurance

  - term: Triple-S Advantage
    definition: >-
      The Medicare Advantage plan subsidiary of Triple-S Management, providing
      Medicare-eligible members in Puerto Rico with comprehensive health coverage.
    category: Subsidiary
    tags:
      - Medicare
      - Insurance

  - term: Triple-S Vida
    definition: >-
      The life insurance subsidiary of Triple-S Management providing individual and
      group life insurance products in Puerto Rico.
    category: Subsidiary
    tags:
      - Life Insurance
      - Insurance

  - term: Salus
    definition: >-
      Medical clinic subsidiary of Triple-S Management offering primary care,
      specialist access, and telemedicine services with integrated electronic health records.
    category: Subsidiary
    tags:
      - Medical Clinics
      - Healthcare