Analysis And Evaluation of Claims Processing for the Period January 1, 2000 Through December 31, 2001 Administered By Blue Cross Blue Shield of Montana : Final Report, April 2002 2002
Analysis And Evaluation of Claims Processing for the Period January 1, 2000 Through December 31, 2001 Administered By Blue Cross Blue Shield of Montana : Final Report, April 2002 2002
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LARGE CASE MANAGEMENT During our audit of the 600 sample claims^ we identified two high dollar claims that were not subject to Large Case Management, However^ other claims for the two patients were subject to Large Case Management.
We believe earlier intervention with Large Case Management could have provided discounts on these large hospital bitls. We recommend BCBSMT encourage earlier intervention X-1 on these high dollar claims* ^^PIGGYBACK" CLAIMS BCBSMT processes some preventive claims as ..."piggyback'', meaning the claim will process on the preventive level first and if the charges exceed the preventive maximum, the claim will then process on the medical level where deductible and coinsurance limits are applied.
We believe this process contradicts the preventive limits outlmed hi the plan documents.
We recommend BCBSMT discuss this procedure with the State and MUS, In the events of the State and MUS disagree, we believe BCBSMT should review all claims affected by this procedure and refund overpayments to the Plan Sponsors and adjust deductible and/or coinsurance accumulators.
What to read after Analysis And Evaluation of Claims Processing for the Period January 1, 2000 Through December 31, 2001 Administered By Blue Cross Blue Shield of Montana : Final Report, April 2002 2002?
You can find similar books in the "Read Also" column, or choose other free books by Wolcott & Associates to read onlineMoreLess
To quickly assess the difficulty of the text, read a short excerpt:
LARGE CASE MANAGEMENT During our audit of the 600 sample claims^ we identified two high dollar claims that were not subject to Large Case Management, However^ other claims for the two patients were subject to Large Case Management.
We believe earlier intervention with Large Case Management could have provided discounts on these large hospital bitls. We recommend BCBSMT encourage earlier intervention X-1 on these high dollar claims* ^^PIGGYBACK" CLAIMS BCBSMT processes some preventive claims as ..."piggyback'', meaning the claim will process on the preventive level first and if the charges exceed the preventive maximum, the claim will then process on the medical level where deductible and coinsurance limits are applied.
We believe this process contradicts the preventive limits outlmed hi the plan documents.
We recommend BCBSMT discuss this procedure with the State and MUS, In the events of the State and MUS disagree, we believe BCBSMT should review all claims affected by this procedure and refund overpayments to the Plan Sponsors and adjust deductible and/or coinsurance accumulators.
What to read after Analysis And Evaluation of Claims Processing for the Period January 1, 2000 Through December 31, 2001 Administered By Blue Cross Blue Shield of Montana : Final Report, April 2002 2002?
You can find similar books in the "Read Also" column, or choose other free books by Wolcott & Associates to read onlineMoreLess
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